The purpose of the study is to determine the effect of kinetic control training on flexion relaxation phenomenon and craniovertebral angle in patients with cervical radiculopathy.
Patients will be referred from neurologist with the diagnosis cervical spondylosis.
Patients will be included if they have unilateral radiculopathy due to spondylotic changes of the lower cervical spine (C5-C6 and C6-C7).
Duration of symptoms is more than three months to avoid acute stage of inflammation.
Patient's age ranged from 40 to 55 years.
Spinal canal stenosis.
Rheumatoid arthritis.
Vertebrobasilar insufficiency.
Spinal instability due to structural cause e.g., spondylolisthesis.
Parallel
Conventional physical therapy program
Other interventionThe conventional physical therapy program will be received for 8 weeks by the two groups. It includes the application of moist heat using a hot pack for ten minutes, followed by continuous ultrasound therapy operated at a frequency of 1 MHz and an intensity of 1.5 W/cm² for five minutes. Transcutaneous Electrical Nerve Stimulation (TENS) will also be utilized, with its development and application based on the Gate Control Theory. TENS will be applied for twenty minutes, with electrodes positioned on either side of the neck at the level of pain, using a pulse rate ranging from 2 to 50 Hz.
Kinetic control training
Other interventionThe Kinetic Control Retraining Program will be received for 8 weeks by the experimental group. It focuses on addressing uncontrolled movement (UCM) and muscle synergy retraining. UCM retraining starts with patient education on movement deficiencies, their symptoms, and adherence to training. Movement coordination is retrained in test positions, progressing to challenging ones using feedback from mirrors, walls, or hands. Corrections focus on lower cervical flexion, upper cervical extension, mid-cervical translation/extension, side-bending, and rotation, emphasizing controlled dissociation in supported and unsupported postures. Muscle synergy retraining targets global stabilizers (e.g., deep neck flexors and extensors) and mobilizers (e.g., sternocleidomastoid and suboccipital muscles) to enhance coordination, stability, and motor control.
Assessment of pain
The Visual analogue scale is used for pain assessment. In this scale, pain is rated from 0 to 100 mm, in which the 0 represented no pain and100 Represented maximum pain tolerance. Subjects are indicated the best number described their pain.
Assessment of craniovertebral angle (CVA)
Markus Bader ruler (MB ruler) is a computer-based objective tool that measure angles and distances. Reflective markers will be placed on participants' anatomical landmarks and a photograph will be taken. The photograph will be uploaded to a computer and the MB ruler software will be used to calculate the CVA.
Assessment of flexion relaxation phenomenon using surface electromyography
Cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Patients will accomplish cervical flexion and extension from a neutral position in four phases in the sitting position. The surface electromyography activity of cervical erector spinae (CES) will be recorded in each phase.
Assessment of disability
The Neck Disability Index (NDI), a modification of the Oswestry Low Back Pain Disability Index, is a widely used instrument for measuring self-rated disability due to neck pain, utilized by clinicians and researchers alike. It is a condition-specific, patient-completed functional status questionnaire consisting of 10 items: pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is scored from 0 to 5, with a maximum score of 50. The total score can be multiplied by two to yield a percentage score, providing a standardized measure of disability.
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