The effect of cervical mobilization on tones, joint position sense and balance in patients with multiple sclerosis

This study was carried out to investigate the effect of cervical mobilization on tone, sense of position and balance in patients with Multiple Sclerosis. A total of 16 individuals, 14 women and 2 men, were included in the study. In the study designed as crossover, individuals received classical rehabilitation and cervical mobilization treatments 2 days a week for 4 weeks in different order by random method. Individuals were kept for a 4-week washout period between treatments. It was treated with stretching, strengthening, coordination, balance and walking exercises for classical rehabilitation while it was treated with joint traction and sliding techniques and soft tissue mobilization techniques myofascial relaxation were applied for cervical mobilization in addition to classical rehabilitation. The patient evaluations were administered for four times, before and after both treatment programs. Spasticity assessed with the Modified Ashworth Scale (MAS); muscles's viscoelastic properties assessed with myotonPRO; joint position sense with digital goniometer; balance assessed with the Berg Balance Scale (BBI) and the Functional Reach Test (FRT); gait functions assessed with Dynamic Gait Index (DGI) and with the Timed 25-Foot Walking Test (T25W). As a result of the study, it was observed that cervical mobilization in addition to classical therapy regulated the muscle's tones and improved the balance of the patients (p<0.05). However, it was determined that clinical development regarding the joint position sense did not reach statistical difference (p>0.05). The period effect was observed only in reducing the tone, it was shown that first cervical mobilization followed by classical physiotherapy program was more effective (p<0.05). In conlucion, cervical mobilization applications could be used as supportive for the reducing the tone, improvement of the proprioceptive system and improvement of balance in terms of treatment efficiency. In addition, we see that both applications complement each other by affecting neural and non-neural mechanisms in spasticity. There is a need for studies investigating the effectiveness of applications by developing manual therapy protocols for the cervical region in different neurological diseases and how permanent these effects are. Keywords: Muscle tones, Manual therapy, Multipl sclerosis, Postural control, Cervical region.