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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 12
| Issue : 4 | Page : 199-206 |
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Efficacy of sustained natural apophyseal glides in the management of mechanical neck pain: A randomized clinical trial
Sharick Shamsi1, Faisal M Alyazedi2, Samiha Mohamed Abdelkader3, Shabana Khan1, Ali Akhtar4
1 Department of Physiotherapy, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
2 Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Kingdom of Saudi Arabia
3 Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
4 Department of IT and Quality, Researcher IT and Quality Unit, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| Date of Submission | 01-Mar-2021 |
| Date of Decision | 05-Apr-2021 |
| Date of Acceptance | 11-Apr-2021 |
| Date of Web Publication | 28-Oct-2021 |
Correspondence Address:
Dr. Sharick Shamsi
Department of Physiotherapy, Prince Sultan Military Medical City, Riyadh
Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/injms.injms_30_21
Background: Neck pain is the second largest cause of disability worldwide. The chronic neck pain prevalence is 14% which is somewhat higher in females as compared to males. In India, the reported prevalence is 6%. Therapeutically, neck pain is managed by physiotherapists using rest, stretching and strengthening exercises, educating patient, and intense proprioception and positional exercises. Aim: We aimed to determine the evidences for the efficacy of sustained natural apophyseal glides (SNAG s) in the management of mechanical neck pain. Methods: One hundred patients (age group: 25–45 years) who were diagnosed with neck pain, with onset >1–3 months (chronic), were randomly assigned to Group A receiving conventional physiotherapy plus SNAGs and Group B receiving conventional physiotherapy plus ultrasound (US). Treatment was given for three times a week for the period of 2 weeks, once a day for 6 sessions. Before treatment and after 2 weeks of treatment, pain, range of motion (ROM), and neck disability were assessed on Visual Analog Scale (VAS), goniometer, and Neck Disability Index (NDI), respectively. This study was conducted in Raj Nursing and Paramedical College, Gorakhpur, ClinicalTrials.gov registration number: NCT04617288. Results: Patients in Group A that received conventional physiotherapy plus SNAGs showed greater improvement in pain and ROM compared with the conventional physiotherapy plus US group on the 2nd week compared with pretreatment (P < 0.050). Conclusion: The result of the study suggests that both the SNAG and US groups improve the symptoms of neck pain. The US group improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results, conventional physiotherapy plus SNAGs should be the treatment of choice for neck pain rather than conventional physiotherapy plus US.
Keywords: Exercise, neck pain, SNAGs, ultrasound
How to cite this article:
Shamsi S, Alyazedi FM, Abdelkader SM, Khan S, Akhtar A. Efficacy of sustained natural apophyseal glides in the management of mechanical neck pain: A randomized clinical trial. Indian J Med Spec 2021;12:199-206 |
How to cite this URL:
Shamsi S, Alyazedi FM, Abdelkader SM, Khan S, Akhtar A. Efficacy of sustained natural apophyseal glides in the management of mechanical neck pain: A randomized clinical trial. Indian J Med Spec [serial online] 2021 [cited 2023 Jun 7];12:199-206. Available from: http://www.ijms.in/text.asp?2021/12/4/199/329469 |
| Introduction | |  |
Neck pain is the second largest cause of disability worldwide. Approximately 70% of individuals are affected during their life causing great burden on society and its economy in the form of expenditures for healthiness and abstinence from working area.[1] The reported chronic neck pain prevalence is somewhat higher in females (5.7%) as compared to males (3.9%).[2] Its prevalence in the world ranges from 16.7% to 75.1%.[3] Chronic neck pain can be related to pain associated along with myotomes referred to the front of chest, upper limb, and thoracic spinal areas. It is acknowledged that neurological assessment of patients having no sign of nerve root being compressed or irritated may be normal. Other than pain, neck problems are also associated with functional impairments in about 10% of patients and disabilities in 5% in cervical region.[4] Due to this uneasiness in and around neck region, people suffering from neck disorders are not able to perform exercise as prescribed.[5] Therapeutically, neck pain is managed by physiotherapists using rest, stretching and strengthening exercises, educating patient, and intense proprioception and positional exercises.[6]
Clinically, manual therapists use various techniques to the muscles and joints for treating pain having mechanical origin, including soft-tissue treatment interventions, such as various kinds of massage (shiatsu), myofascial trigger point (MTrP) release therapy, dry needle and acupuncture, manipulation, and mobilization with manual traction.[7]
Limited researches[8],[9] showed a comparison of therapeutic interventions such as electrotherapy modalities and exercises along with manual therapies that are far better in neck pain treatment. In randomized controlled trial (RCT), Ayse and Ummuhan[10] showed that combination therapy treatment program including thermotherapy, Transcutaneous electrical nerve stimulation, therapeutic massage, therapeutic exercises, and recommendations for daily living activities in addition to US and phonophoresis to experimental groups had positive effects in improving pain intensity, disability, and quality of life scores in the management of patients with chronic neck pain.
Earlier researches have publicized that therapeutic US reduces tightness in muscle and increases joint range of motion (ROM) actively.[11] However, its therapeutic application for neck pain is not yet explored widely. The strategies and latest studies of therapeutic US have discovered contradictory or inadequate suggestions related to its efficiency and have highlighted the necessity for further investigation to explore the accurate effect of this broadly used therapy. Therefore, it could be of great value to examine additionally the beneficial effects of US on neck pain and inspect potential ways of decreasing pain and improving ROM.
Evidence is rare regarding which conventional therapy or their combination is greatest in effect in managing neck pain. Although mobilization and manipulations in cervical spine are generally engaged in therapy for signs from conditions in neck region, argument still remains about possible useful effects of the use of each management.
Thus, the purpose of this research is to make the comparison of efficacy of SNAG mobilization and therapeutic ultrasound (US) application in managing individuals having pain (mechanical) and disability in cervical region.
| Methods | | |
One hundred patients of age 20–45 years were included in study sample. Patients were allocated into two groups, depending on predefined inclusion and exclusion criteria. Group A receiving conventional physiotherapy treatment (moist hot pack [MHP] and neck stretching and strengthening exercises) along with SNAGs as per the guidelines mentioned in Mulligan concepts or Group B receiving conventional physiotherapy plus US each consisting of 50 patients. Patients in each group were treated 3x/week (2 weeks), once a day for 6 sessions. Measurements of results were taken before intervention as pretest and end of the intervention after 2 weeks.[1] ROM, pain, and neck disability were measured with universal goniometer (UG), Visual Analog Scale (VAS), and Neck Disability Index (NDI), respectively. This research was conducted on Raj Nursing Home, and ethical approval is taken from Raj Nursing and Paramedical College, ClinicalTrials.gov registration number: NCT04617288.
Randomization criteria
Patients were allocated randomly to two groups. Groups were assigned by preparing small pieces of paper equal to the number of patients. Method of intervention was written on paper pieces, which were then put into a container by someone who was blinded to them. Patients (blinded) were then asked to pick one piece of paper from the container to specify treatment type for each patient.
Sample size calculation
The sample size was calculated as per method used in a similar study[12] (n = 90) using the Neck Pain Questionnaire, having mean as 13.99 and standard deviation (SD) as 5.823 of neck pain score, supposing that the experimental group improved by 50% and the control group improved by 25%. At a correlation of 0.5 between pre- and postmeasurements, having SDs in pre–postintervention measurements almost similar, SD for the differences between them will be almost similar as initial measurement. At 5% alpha, 90% power, and biside alternate test on change between pre- and postmeasurements, it could be expected that 50–60 patients will be needed for every group.
Inclusion criteria
- Age group between 20 and 45 years
- Both gender male and female
- Individuals having localized pain or stiffness in spine or both combined between C3 and C7 without upper-limb radiculopathy[13]
- Pain reported on VAS score >3/10 in neck region for more than 3 months
- Patients agree to sign written consent form.
Exclusion criteria
Patients were excluded if they were diagnosed with the following conditions for >6 months:[1],[13]
- Tuberculosis, carcinoma, heart disease, and osteoporosis
- Neural disorders due to prolapsed intervertebral disc
- Any trauma or localized infection in neck region
- Upper motor neuron disease, cervical stenosis, and metabolic diseases in bone and joint
- Hyperflexibility
- Open sores
- Ongoing radiotherapy, chemotherapy, steroid therapy, or anticoagulants
- Psychiatric diseases such as phobia/obsession and depression
- Allergy to hot pack
- Patients with history of surgery in cervical spine region with in a year.
Design
This was a RCT with pre- and post-test design. [Figure 1] illustrates the strata allocation and randomization of group assignment. | Figure 1: Flowchart illustrating strata allocation and randomization of group assignment
Click here to view |
Procedure
Treatment procedure for ultrasound therapy
US was given to a patient sitting on chair while the treating physiotherapist stands behind, with 1 MHz of frequency and 1.0 W/cm2 of intensity and on continuous mode for duration of 10 min, on bilateral trapezius trigger points, in circular motion using US gel for conduction [Figure 2].[8],[9]
Treatment procedure for SNAGs
SNAGs are sustained natural apophyseal glides whereby the patient attempts to actively move a painful or stiff joint through its ROM while the therapist overlays an accessory glide parallel with the treatment plane.[14]
SNAG mobilization was given to a patient (as defined by Mulligan) sitting on chair while the treating physiotherapist stands behind by placing medial border of distal phalanx of thumb on the spine of one vertebra above affected region. The glides were given with tip of thumb placed at an angle of 45° along the eyeball direction reinforced by another thumb. In session, glides were repeated six times and three sets were given[14] [Figure 3].
Treatment procedure for conventional therapy
All patients received MHP for 15 min on neck area while sitting with head relaxing on couch with a pillow.[13],[15]
Stretching exercises for neck muscles
Upper trapezius muscle stretching
The patient sat on a stool in an erect position. The treating physiotherapist stands behind him/her with one hand on a patient's shoulder for stabilization while the other placed on side of head. The stretching was applied by moving the head in side bending with holding for 30 s and rest for 30 s and repeated three times to both sides.[16]
Stretching exercises for neck rotators
The patient was seated on a stool. The physiotherapist stands on his/her back with one hand on patient's shoulder while the other on head laterally. Stretching exercise was applied by application of passive full-neck rotation toward right and left directions as much as possible but within limit of pain. The patient holds for 30 s, with rest of 30 s and repeated three times.[16]
Isometric strengthening exercises for neck muscles
Each exercise was repeated for ten repetitions with 10 s hold per session.[16]
Isometric strengthening exercises for neck extensors
The patient sits on a stool in an erect position. The therapist stands behind the patient with one hand on his/her shoulder while the other on occipital region. The patient asked to push the therapist's hand, while the therapist resisted the movement, so there was no neck movement.[16]
Isometric strengthening exercises for neck flexors
The patient sits on a stool in an erect posture. The physiotherapist stands on his/her back with one hand on his/her shoulder while the other on forehead. The patient asked to push the therapist's hand, while the therapist resisted the movement, so there was no neck movement.[16]
Isometric strengthening exercises for neck rotators
The patient sat on a stool in an erect position. The therapist stands behind the patient with one hand on his/her shoulder, while the other was on the side of head. The patient was asked to push the physiotherapist's hand backward and try to rotate the head to right and left, while the therapist resisted the movement without neck movement.[16]
Isometric strengthening exercises for neck side bending muscles
The patient sits on a stool in an erect position. The therapist stands behind the patient with one hand on his/her shoulder, while the other was on occipital region. The patient asked to push the therapist's hand and try to side bend the neck to right and left, while the therapist resisted the movement without neck movement.[16]
Measurement
All ranges in neck region (6°) were measured using UG while the patient sat on a chair in erect position having his/her arms rested at side. A large UG having 12” arms and full-circle body was used for measuring Active Cervical Range of Motion (ACROM). It is commonly used to measure joint ROM in clinics.[17]
Pain intensity was assessed using a VAS ranging from 0 to 10 (0 = no pain and 10 = intolerable pain), wherein the patient marked a point according to her/his level of pain.[18] Disability was assessed using the NDI. The NDI contains 10 items: 7 related to activities of daily living (ADL), 2 related to pain, and 1 related to concentration. Each item is scored from 0 to 5, and the total score is expressed as a percentage, with higher scores corresponding to greater disability.[19],[20]
Data analysis
Data were analyzed by IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp, using t-test for comparing effects of treatments on cervical ROM (CROM), NDI, and VAS between Groups A and B. Mean and SD for pre- and posttest measurements were calculated for each group. The level of significance was ≤0.05.
| Results | | |
We included 100 patients with a mean age of 30.82 ± 6.75 (Group A: 31.42 ± 6.67 and Group B: 30.82 ± 6.82) ranging from 20 to 45 years, with a mean height of 165.52 ± 7.85 (Group A: 164.92 ± 7.79 and Group B: 166.12 ± 7.87) cm [Table 1]. | Table 1: Mean and standard deviations of age and height between Groups A and B
Click here to view |
Visual Analog Scale and Neck Disability Index scale
Within-group comparison of Visual Analog Scale and Neck Disability Index
There was a significant difference between the two groups in pre- and posttest values for VAS and NDI variables as P values for Groups A and B were P <0.001 and P ≤ 0.05, respectively. t-test shows statistically significant (highly) improvement in pain (VAS) and neck disability (NDI) [Table 2], [Table 3]. | Table 2: Within-group comparison of Visual Analog Scale for Groups A and B
Click here to view |
Between-group comparison of Visual Analog Scale
VAS values were compared between the two groups at pretest (baseline, 0 day) and posttest (end of 2 weeks). At pretest, the mean values for VAS for Groups A and B were 6.48 ± 1.09 and 6.34 ± 1.27, respectively. t-test shows that these values were not significant statistically as P = 0.543 at P ≤ 0.05. At posttest, the mean values of VAS for Groups A and B were 0.44 ± 0.60 and 0.68 ± 0.85, respectively. t-test shows that these values were significant statistically as P = 0.032 at P ≤ 0.05 [Table 4]. | Table 4: Between-group comparison of Visual Analog Scale for Groups A and B
Click here to view |
Between-group comparison of Neck Disability Index
NDI values were compared between the two groups at pretest (baseline, 0 day) and posttest (end of 2 weeks). At pretest, the mean values for NDI for Groups A and B were 33.24 ± 5.96 and 31.24 ± 7.52, respectively. t-test shows that these values were not significant statistically as P = 0.137 at P ≤ 0.05. At posttest, the mean values of NDI for Groups A and B were 14.48 ± 3.68 and 18.3 ± 6.23, respectively. t-test shows that these values were significant (highly) statistically as P = 0.000 at P ≤ 0.05 [Table 5]. | Table 5: Between-group comparison of Neck Disability Index for Groups A and B
Click here to view |
Neck active range of motion
Active range of motion (AROM) was one of the dependent variables used in the study; it was recorded as pretreatment (0 day) and posttreatment (end of 2 weeks) in both the groups.
Within-group analysis of neck active range of motion
In within-group analysis, both the groups had a significant difference in pre- and posttest values as P values for Groups A and B were P < 0.001 and P < 0.001, respectively. This shows that there was statistically significant improvement in neck AROM (flexion, extension, right side flexion, left side flexion, right rotation, and left rotation) in both the groups [Table 6]. | Table 6: Within-group comparison of neck active range of motion (flexion, extension, right side flexion, left side flexion, right rotation, and left rotation) in degrees for Groups A and B
Click here to view |
Between-group analysis of neck active range of motion
Neck active ranges between the two groups were compared at pretest (0 day) and posttest (end of 2 weeks).
Between-group analysis of neck flexion active range of motion
At pretest, the mean values of neck flexion AROM for Groups A and B were 22.38 ± 3.46 and 21.48 ± 3.73, respectively. t-test shows that these values were not significant statistically as P = 0.114 at P ≤ 0.05. At posttest, the mean values of neck flexion AROM for Groups A and B were 43.64 ± 3.95 and 34.02 ± 3.88, respectively. t-test shows that these values were significant statistically as P < 0.001 at P ≤ 0.05 [Table 7]. | Table 7: Between-group comparison of neck active range of motion (flexion, extension, right side flexion, left side flexion, right rotation, and left rotation) in degrees for Groups A and B
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Between-group analysis of neck extension active range of motion
At pretest, the mean values of neck extension AROM for Groups A and B were 23.32 ± 3.55 and 21.04 ± 2.68, respectively. t-test shows that these values were not significant statistically as P = 0.090 at P ≤ 0.05. At posttest, the mean values of neck extension AROM for Groups A and B were 42.9 ± 4.42 and 33.32 ± 3.02, respectively. t-test shows that these values were significant statically (highly) as P < 0.001 at P ≤ 0.05 [Table 7].
Between-group analysis of neck right side flexion active range of motion
At pretest, the mean values of neck side flexion AROM for Groups A and B were 22.04 ± 3.01 and 21.08 ± 3.32, respectively. t-test shows that these values were not significant statistically as P = 0.109 at P ≤ 0.05. At posttest, the mean values of neck side flexion AROM for Groups A and B were 36.46 ± 2.53 and 33.66 ± 3.97, respectively. t-test shows that these values were significant statistically as P < 0.001 at P ≤ 0.05 [Table 7].
Between-group analysis of neck left side flexion active range of motion
At pretest, the mean values of neck left flexion AROM for Groups A and B were 21.82 ± 2.70 and 20.02 ± 2.72, respectively. t-test shows that these values were not significant statistically as P = 0.080 at P ≤ 0.05. At posttest, the mean values of neck side flexion AROM for Groups A and B were 36.48 ± 2.79 and 32.54 ± 3.68, respectively. t-test shows that these values were statistically statically as P = < 0.001 at P ≤ 0.05 [Table 7].
Between-group analysis of neck right rotation active range of motion
At pretest, the mean values of neck right rotation AROM for Groups A and B were 43.18 ± 6.22 and 43.01 ± 7.34, respectively. t-test shows that these values were not significant statistically as P = 0.950 at P ≤ 0.05. At posttest, the mean values of neck right rotation AROM for Groups A and B were 64.92 ± 5.21 and 55.03 ± 7.07, respectively. t-test shows that these values were significant statistically as P < 0.001 at P ≤ 0.05 [Table 7].
Between-group analysis of neck left rotation active range of motion
At pretest, the mean values of neck left rotation AROM for Groups A and B were 43.04 ± 4.95 and 40.48 ± 6.29, respectively. t-test shows that these values were not significant statistically as P = 0.061 at P ≤ 0.05. At posttest, the mean values of neck left rotation AROM for Groups A and B were 66.1 ± 4.91 and 53.94 ± 6.14, respectively. t-test shows that these values were significant statistically as P = < 0.001 at P ≤ 0.05 [Table 7].
Thus, it can be concluded from the above results that both the interventions (SNAGs and US application) were effective in decreasing pain and improving CROM, as reflected by VAS, NDI, and ACROM, respectively. However, statistically significant improvement was reported only after 2 weeks of intervention protocol in both the groups.
| Discussion | | |
The present research revealed that both groups (A and B) had a significant decrease in severity of MTrP pain, neck disability, and improved neck ROM at the end of 2 weeks of intervention. On the contrary, patients in Group A (SNAGs) presented better improvement compared to Group B (US). Thus, we propose the use of multimodal management for neck pain mainly due to the achievement of positive effects of both interventions at the same time, enhancing the effectiveness of one intervention over the other making treatment more effective rather than using each treatment alone. US is utilized in physiotherapy to deactivate TrPs. Several articles are available concerning the effectiveness of US in musculoskeletal conditions. However, only a few of them have investigated the effects of US on both pain and ROM.
The improvement in pain strength found in our research is in accordance with the result of Soysala and Aslanb who recommended that US in combination with conventional therapy procedures can affect positively pain strength in chronic neck pain individuals.[21] In addition, Celik et al. established that therapeutic uses of US are beneficial in decreasing pain intensity and improving ROM in neck region mechanical neck pain patients.[22]
Physiotherapy interventions hustle deterioration of distress and difficulties by improving ADLs of affected individuals. On the basis of outcomes of the study, few facts lead to given conclusions:
- Outcomes of the study revealed decrease in pain in both the groups which was significant statistically; this shows that even without using US, adequate pain-relieving effect can be obtained
- Regression of difficulties such as pain, contraction, tension of paravertebral muscles, lowering of movement in neck segment of spine was achieved with equal intensity and amount of time in both groups, this proves that therapeutic ultrasound does not have more significant therapeutic effect than SNAGs.
- Both SNAGs and Therapeutic Ultrasound were significant in increasing neck.
- AROM, and in decreasing VAS score and NDI in the patients.
Rajesh et al. conducted a study to compare Maitland and Mulligan mobilization techniques for neck pain and ROM. It found that Mulligan mobilization was more effective than Maitland in improving neck pain, functional status of neck, and ROM.[13]
Ali et al. found in their study that the SNAGs when followed by the Isometric Exercise Training Program can better manage pain and disability as compared with the SNAGs alone in the management of nonspecific neck pain (NSNP).[2]
In patients with NSNP, as reported by Samar et al., Maitland and Mulligan mobilization techniques have positive effects on neck pain, functional disability, and selected psychological features with no significant difference between them.[23]
Brosseau et al. developed evidence-based clinical practice guidelines on therapeutic massage for neck pain and suggested that a multimodal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggests less benefit to either manipulation/mobilization or exercise therapy done alone.[24] Similarly, Fahad et al. reported that SNAG mobilization is more effective in the management of NSNP and conventional treatment improved functional status of neck.[25] These studies strongly support the result of our study.
On the contrary, in a study done by Keyur et al., the patients were treated with Maitland mobilization, SNAGs and conventional therapy in 3 groups, respectively. All three interventions were statistically significant in reducing the symptoms of patients. However, Maitland mobilization was found to be more significant in reducing the patient symptoms when it is compared with conventional therapy and SNAG mobilization.[26]
Mobilization techniques could stimulate joint mechanoreceptors to decrease pain (neurophysiologic effect) and to stretch the joint tissues (mechanical effect). The oscillations may have an inhibitory effect on perception of painful stimuli by stimulating mechanoreceptors that block nociceptive pathways at the spinal cord or brain stem levels.[27]
Several researches have revealed that persons having mechanical neck pain have decreased ROM. The outcomes of this research proved that the spinal manipulations in the neck region produced a reoccurrence to neck ROM at near to normal standards.
The SNAGs group showed slightly better improvement than the US group in nearly all of the outcomes related to the subject. Haavik and Murphy added that the effectiveness of spinal manipulation is due to the fact that manipulation can increase the range of motion of the joints, increasing the activity of the proprioceptive fibers and thereby reducing the transmission of pain stimuli, also relieving chronic tension and spinal nerve irritation caused by joint dysfunction.[1] The improvement in the Mulligan group can be attributed to the neurophysiological effects found at the site of treatment and at areas remote to the local area of treatment. These effects include improved pain-related measures such as increased pressure pain threshold and decreased VAS pain rating. The neurophysiological effects of mobilization are important enough to cause a categorical and substantial change in how clinicians and scientists understand the benefits of mobilization. Neurophysiological effects of central posteroanterior mobilization previously have been identified including immediate hypoalgesia and an increase in pressure pain thresholds. When joint tissue is strained at the limits of normal tissue extensibility, nociceptors (pain nerve receptors) are activated, causing a pain response. This could be a possible benefit of the SNAG group proving superior over the US group.[27]
The possible explanation for these results may be due to the ability of accessory sustained facet glides to stretch and stimulate the mechanoreceptors existing inside facet joint capsule and also end range overpressure with SNAGS technique can stimulate the mechanoreceptors existing in ligaments and muscles; it eases the muscles by stretching joint capsules.[28]
Limitations of the study
- Limited and small sample size
- Duration of intervention was relatively short
- We did not perform any regular follow-up program
- Limited to patients with mechanical neck pain
- Blinding of treating therapist was not performed
- Goniometer was used to measured neck ROM, instead electric inclinometer or cervical goniometer could have provided a more accurate measurement.
Scope and suggestions for future research
- Additional researches are required to assess the extended period effectiveness of US and SNAGs in neck pain sufferers, examining longer duration effects along with extended follow-up duration
- Upcoming studies can discover further detailed neck pain disorders
- Bigger sample size is necessary for validation and establishment of this research
- This project can be adapted to improve ROM and decrease pain and functionality in other areas such as low back pain.
| Conclusion | | |
In our judgment, both types of interventions are proved to be beneficial in managing mechanical neck pain in view of the effects found in our research. The SNAGs group showed better in improving the intensity of pain, neck disability, and ROM in comparison with the US group, in patients having mechanical neck pain assessed through VAS, NDI, and goniometry. Thus, SNAGs have shown to be a better statistically significant and clinically effective treatment when compared with therapeutic US. Thus, we conclude that SNAG mobilization illustrated better improvement in neck ROM, pain, and neck disability in patients with mechanical neck pain. These findings can be useful for scientific research for beneficial properties of SNAGs and US on pain, disability, and ROM.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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