Efficacy of sustained natural apophyseal glides in the management of mechanical neck pain: A randomized clinical trial

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.