Short-term Effect of Mulligan SNAGs on Pain Intensity, Cervical Range of Motion and Craniovertebral Angle in Patients with Non Specific Neck Pain: A Quasi-experimental Study

Abstract

Introduction: The extended use of smartphone, laptops and computers alters the posture of the neck which results in non specific neck pain. Though the physical therapy modalities give symptomatic relief, the forward head posture is left uncorrected. Mulligan Sustained Natural Apophyseal Glides (SNAGs) stimulate the mechanoreceptors and proprioceptors around the joints that might correct the faulty posture of neck. Aim: To evaluate the short-term effect of mulligan SNAGs on pain intensity, cervical range of motion and craniovertebral angle in patients with non specific neck pain. Materials and Methods: This quasi-experimental study was conducted in Department of Physical Medicine and Rehabilitation at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India, from August 2021 to October 2021. Total 20 patients diagnosed having non specific neck pain and Craniovertebral angle (CV) angle less than 45 degrees were included in the study. The participants were randomly allotted into two groups. Group A received interferential therapy and static neck exercises. Whereas, group B received Mulligan SNAGs in addition to interferential therapy and static neck exercises and serves as the experimental group. Mulligan SNAGs was given to each cervical movement as six repetitions×two sets/session×three sessions/week. The intervention was given for two weeks. Preintervention and postintervention evaluation of pain intensity, cervical range of motion and CV angle was made and statistically analysed using Paired t-test for within group analysis and independent t-test for between group analysis at 5% level of significance (p-value <0.05). Results: The mean age the participants in group A was (32.2±6.3 years) and group B was (32.7±6.03). Within group analysis was made and it was observed that group A and B showed significant reduction in Numerical Pain Rating Scale (NPRS) score (p-value=0.004, p-value=0.005), improvement in CV angle (p-value=0.001, p-value=0.001) and increased cervical range of flexion (p-value=0.001, p-value=0.001), cervical extension (p-value=0.004, p-value=0.001) and rotation movements (p-value <0.05), respectively. The between group analysis of pre-post mean differences in the NPRS score (3.30±0.67, 4.60±0.96), CV angle (0.46±0.24, 5.62±1.21), cervical movement of flexion (10±2.36, 19±4.59), extension (6.50±2.53, 21±8.23), right lateral rotation (8±2.58, 15±4.08) and left lateral rotation (8.5±2.49, 16±4.24) was made using Independent samples t-test. It was observed that, all the outcomes showed significant difference. The mean difference in the outcome measures were significantly greater in group B who received mulligan SNAGs than group A. Conclusion: Thus, the short-term application of Mulligan SNAGs along with conventional physiotherapy proves good in reducing pain, improving cervical range of motion and normalising the reduced CV angle in patients with non specific neck pain.

Keywords

• electronic head posture instrument
• forward head posture
• interferential therapy
• mulligan sustained natural apophyseal glide