All patients are instructed to perform a home program involving chin-in exercises from a supine position, focusing on upper cervical spine extension and flexion. Participants will move their heads backwards and then return to the starting position, ensuring slow, controlled movements while palpating their necks to relax superficial neck muscles. The exercises will be done twice a week for six weeks, with each hold lasting 10 seconds, 15-second breaks between holds, and 10-15 repetitions in total.

In a supine position with the head on a pillow, the patient is treated by a therapist seated at the head of the table. The therapist uses both hands (digits 2 to 5) to contact the base of the occiput, gently lifting the head anteriorly while allowing the dorsum of the hands to rest on the pillow. This technique involves cranial pulling as the patient's sub occipital muscles relax, with distraction maintained for up to 5 minutes as tissue slack becomes available. Once relaxation is achieved, the therapist positions the shoulder against the patient's forehead to enhance sub occipital distraction.

The therapy procedure involves positioning the patient supine and performing specific movements to address shoulder and neck tension. The therapist supports the occiput and rib area while guiding the neck into forward bending and lateral flexion, combined with right or left rotation, depending on the sequence. The patient is instructed to perform isometric contractions by elevating the shoulder against resistance for 10 seconds, followed by relaxation, with additional stretches held for 10 seconds. This process is repeated three to four times and includes a home stretching program, holding stretches for 30 to 60 seconds two to three times daily.

The patient is positioned prone with a pillow under their chest, and their head and neck are in a neutral position, while the therapist stands at the head. The therapist places both thumbs on the spinous process of the targeted vertebra and applies a gentle posterior to anterior force to assess pain, mobility, and end feel, gradually increasing the force for four to five repetitions.

Triton decompression system is designed to apply traction to the cervical vertebrae in patients grouped as A, B, and C. The system includes a Triton decompression traction unit and a QuikWrapTM belting system, with traction starting from specified angles (flexion, lateral bending and rotation according to pain) and an initial force of 10% of the patient's body weight, increasing by 1-2 kg as needed. Each session consists of 20 minutes of intermittent traction, allowing stress management through a bursar switch. Concurrently, neural mobilization involves shoulder depression and arm abduction, leading into either sliding or gliding of the median nerve, performed over specific sets and repetitions with designated rest periods.

Triton decompression system is designed to apply traction to the cervical vertebrae in patients grouped as A, B, and C. The system includes a Triton decompression traction unit and a QuikWrapTM belting system, with traction starting from specified angles (30 degree) side bending and an initial force of 10% of the patient's body weight, increasing by 1-2 kg as needed. Each session consists of 20 minutes of intermittent traction, allowing stress management through a bursar switch. Concurrently, neural mobilization involves shoulder depression and arm abduction, leading into either sliding or gliding of the median nerve, performed over specific sets and repetitions with designated rest periods.

Flexor carpi radialis H-reflex is measured using an electromyogram in a semi-supine position with a supinated forearm. Hair may be removed from the anterior forearm to reduce signal resistance. The motor point of the Flexor carpi radialis is identified by applying low-threshold stimuli, aiming for the maximum response at the lowest threshold. A recording electrode is positioned at this motor point, with a reference electrode on the lateral forearm and a ground electrode proximally. To elicit the H-reflex, a surface-stimulating electrode is applied along the median nerve in the antecubital fossa.

High-resolution ultrasonography will utilize a 12- to 18-MHz linear probe to assess cervical nerve roots (NR) in seated patients with lateral neck flexion. Contralateral unaffected nerve root will serve as controls. To minimize anisotropy, the transducer will be positioned at right angles and rotated to identify the minimal cross-sectional area. C7 vertebra identification will precede imaging of the anterior and posterior tubercles of C6. The transducer will be moved to capture axial views of C5, C6, and C7 nerve roots, maintaining proximity to the transverse processes at the nerve root exit points.