Sustained Natural Apophyseal Glides With and Without Integrated Neuromuscular Inhibition Technique in Neck Pain

February 4, 2026 updated by: Riphah International University

Effects of Sustained Natural Apophyseal Glides With and Without Integrated Neuromuscular Inhibition Technique on Pain, Range of Motion, and Function in Patients With Chronic Mechanical Neck Pain

The study was conducted to determine the effects of Sustained Natural Apophysial Glide with and without Integrated Neuromuscular Inhibition Technique on pain, range of motion and function in patients with chronic mechanical neck pain

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
44

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan
        • Lahore General Hospital,Lahore

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age ranged from 18 to 45 years and both genders.
  • Patient having neck-pain symptoms for more than 3 months duration.
  • Spurling test, distraction test, upper limb tension test and shoulder abduction test negative upon assessment.
  • The participants should have MTrPs in any one of these following cervical muscles which include levator scapulae, upper trapezius, splenius capitis and sternocleidomastoid muscles which may be active or latent.
  • A score greater than twenty percent on NDI.
  • Jump Sign when pressure is applied.
  • Positive Simons criteria which contains following these 5 characteristics :(1) Pain on palpation (2) pain that is radiating (3) Tightened cord like structure in muscle fiber that is detectable upon palpation(4) Reduced Flexibility of that muscle (5) 'twitching response' on needling.
  • Participants who described pain which is felt between spinous process of 1st thoracic vertebrae and superior nuchal line in posterior or posterolateral part of neck

Exclusion Criteria:

  • Recent fracture, trauma (whiplash injury) and surgery in and around the shoulder and neck
  • Neural disorders due to prolapsed intervertebral disc
  • Carcinoma, Heart diseases, Metabolic disease in bone and joints
  • Patients having history of osteoporosis, prolong steroid and analgesics use
  • Unstable spine and open sores, Localized infection in neck
  • Vertebrobasilar insufficiency.
  • Cervical radiculopathy and myelopathy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Sustained Natural Apophyseal Glides With Integrated Neuromuscular Inhibition Technique
Other: Sustained Natural Apophyseal Glides
SNAGs were applied in three sets, with repetitions progressively increased from 6 to 10 over a period of four weeks, administered three times per week.
Other: Integrated Neuromuscular Inhibition Technique
The integrated neuromuscular inhibition technique comprised three steps: ischemic compression, strain-counterstrain technique, and muscle energy technique. The technique was applied to the upper trapezius, levator scapulae, sternocleidomastoid, and splenius capitis muscles. Muscle selection was based on palpatory examination performed prior to each treatment session. Each treatment session lasted 10 minutes, during which all three steps were repeated three times within a single session. The intervention was delivered three times per week for four weeks, resulting in a total of 12 treatment sessions.
Other: Standardized Physiotherapy Treatment
Standardized physiotherapy included the application of an electrical hot pack at moderate intensity for 10 minutes. Transcutaneous electrical nerve stimulation (TENS) delivered in continuous mode at a frequency of 100 Hz for 15 minutes. Passive stretching was performed for cervical muscles prone to tightness, including the levator scapulae, sternocleidomastoid, upper trapezius, and scalene muscles, with a 30-second hold, three sets of ten repetitions, and a one-minute rest between sets. Scapular stabilization exercises, comprising shoulder shrugging and scapular retraction, were performed for 15 repetitions with a 6-second hold. Neck isometric exercises were repeated ten times with a 6-second hold. Cervical stabilization exercises were performed in two sets of ten repetitions per session, with each repetition held for ten seconds, a forty-second rest between repetitions, and a two-minute rest between sets.
Active Comparator: Sustained Natural Apophyseal Glides
Other: Sustained Natural Apophyseal Glides
SNAGs were applied in three sets, with repetitions progressively increased from 6 to 10 over a period of four weeks, administered three times per week.
Other: Standardized Physiotherapy Treatment
Standardized physiotherapy included the application of an electrical hot pack at moderate intensity for 10 minutes. Transcutaneous electrical nerve stimulation (TENS) delivered in continuous mode at a frequency of 100 Hz for 15 minutes. Passive stretching was performed for cervical muscles prone to tightness, including the levator scapulae, sternocleidomastoid, upper trapezius, and scalene muscles, with a 30-second hold, three sets of ten repetitions, and a one-minute rest between sets. Scapular stabilization exercises, comprising shoulder shrugging and scapular retraction, were performed for 15 repetitions with a 6-second hold. Neck isometric exercises were repeated ten times with a 6-second hold. Cervical stabilization exercises were performed in two sets of ten repetitions per session, with each repetition held for ten seconds, a forty-second rest between repetitions, and a two-minute rest between sets.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Numeric Pain Rating Scale
Time Frame: From enrollment to end of treatment at 4th weeks
Numeric Pain Rating Scale is utilized to evaluate pain.This is a scale between 0 and 10 where 0 denotes no pain and 10 denotes the worst pain whereas 1-3 denotes mild pain 4-6 denotes moderate pain and 7-10 denotes severe pain.
From enrollment to end of treatment at 4th weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Neck Disability Index
Time Frame: From enrollment to the end of treatment at 4th weeks
The Neck Disability Index is a self-reported questionnaire used to assess neck-related functional disability. It consists of 10 items addressing pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is scored on a 6-point scale (0-5), with a total score ranging from 0 to 50, where higher scores indicate greater disability. Scores are categorized as no disability (0-4), mild disability (5-14), moderate disability (15-24), severe disability (25-34), and complete disability (≥35).
From enrollment to the end of treatment at 4th weeks
Range of Motion Cervical Spine (Flexion)
Time Frame: From enrollment to the end of treatment at 4th week.
Changes in cervical spine flexion range of motion at baseline and 4th week of intervention was measured using goniometer
From enrollment to the end of treatment at 4th week.
Range of Motion Cervical Spine (Extension)
Time Frame: From enrollment to the end of treatment at 4th week
Changes in cervical spine extension range of motion at baseline and 4th week of intervention was measured using goniometer.
From enrollment to the end of treatment at 4th week
Range of Motion Cervical Spine (Lateral Flexion) Right Side
Time Frame: From enrollment to the end of treatment at 4th week
Changes in cervical spine lateral flexion on right side range of motion at baseline and 4th week of intervention was measured using goniometer.
From enrollment to the end of treatment at 4th week
Range of Motion Cervical Spine (Lateral Flexion) Left Side
Time Frame: From enrollment to the end of treatment at 4th week
Changes in cervical spine lateral flexion on left side range of motion at baseline and 4th week of intervention was measured using goniometer.
From enrollment to the end of treatment at 4th week
Range of Motion Cervical Spine (Rotation) Right Side
Time Frame: From enrollment to the end of treatment at 4th week
Changes in cervical spine rotation on right side range of motion at baseline and 4th week of intervention was measured using goniometer
From enrollment to the end of treatment at 4th week
Range of Motion Cervical Spine (Rotation) Left Side
Time Frame: From enrollment to the end of treatment at 4th week
Changes in cervical spine rotation on left side range of motion at baseline and 4th week of intervention was measured using goniometer
From enrollment to the end of treatment at 4th week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Riphah International University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Syed Shakil ur Rehman, Ph.D, Riphah International Universirty

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 18, 2025

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
November 18, 2025

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
November 18, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 4, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 4, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 11, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
February 11, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 4, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • REC/RCR & AHS/24/0175

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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