The Effects of Mulligan Joint Mobilization and Instrument-Assisted Soft Tissue Mobilization in Individuals With Neck Pain

March 18, 2026 updated by: Ozden Baskan, Istanbul Rumeli University

Comparison of the Effects of Mulligan Joint Mobilization and Instrument-Assisted Soft Tissue Mobilization on Pain Intensity, Cervical Awareness, and Functionality in Individuals With Chronic Neck Pain

The study will include a total of 40 individuals aged 18-65 years with chronic neck pain for at least three months. Participants will be randomly assigned to two groups: the Mulligan mobilization group (n=20) and the AYDM group (n=20). Both groups will receive a total of 12 treatment sessions, 3 days a week for 4 weeks. Assessments will be performed before and after treatment. Pain intensity will be assessed using the Visual Analog Scale (VAS), cervical awareness using the Fremantle Neck Awareness Questionnaire (FNA), and functionality using the Copenhagen Neck Functional Disability Scale (CNFDS). In addition, measurements of cervical joint range of motion, deep neck flexor muscle endurance, quality of life (SF-36), and depression level (Beck Depression Scale) will be taken.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

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 (Estimated)

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.
40

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

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
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • • Volunteering to participate in the study

    • Being between 18 and 65 years of age
    • Having experienced mechanical neck pain for at least 3 months
    • Not having any contraindications for manual therapy

Exclusion Criteria:

  • Receiving a diagnosis of a psychiatric illness

    • Having a history of spinal surgery
    • Having other musculoskeletal problems that may affect the cervical region (such as scoliosis, shoulder pathologies, thoracic outlet syndrome)
    • Having received physiotherapy for neck and back problems within the last year.

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: Single

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.
Active Comparator: Mulligan
In line with the Mulligan Concept, natural apophyseal gliding (NAGs) and sustained natural apophyseal gliding (SNAGs) techniques will be applied.
Other: Mobilization
The treatments will administered 3 days a week for a total of 12 sessions over 4 weeks.
Active Comparator: Instrumental Soft Tissue Mobilization
In the Instrumental Soft Tissue Mobilization (ITSM) group, participants will undergo bilateral procedures on the upper and middle trapezius muscles, levator scapulae, sternocleidomastoid (SCM), anterior, medius and posterior scalene muscle groups, erector spine, and suboccipital muscles.
Other: Instrumental Soft Tissue Mobilization
The treatments will administered 3 days a week for a total of 12 sessions over 4 weeks.

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
Pain Intensity
Time Frame: Baseline and at the end of treatment (week 4)
Visual Pain Scale.Participants' pain intensity will be assessed using the Visual Analog Scale (VAS). The Visual Analog Scale is a validated and reliable scale that quantitatively determines the intensity of pain perceived by an individual. The scale consists of a 10 cm long horizontal or vertical line, with one end of the line defined as "0 = no pain" and the other end as "10 = unbearable pain".
Baseline and at the end of treatment (week 4)
Range of motion
Time Frame: Baseline and at the end of treatment (week 4)
To assess the active range of motion of the cervical joint, the tape measure method described by Hsieh et al. (1986) was used. This method is reported to be a practical and reliable measurement tool for assessing cervical range of motion in clinical practice.
Baseline and at the end of treatment (week 4)
Cervical awareness
Time Frame: Baseline and at the end of treatment (week 4)
Fremantle Neck Awareness Questionnaire
Baseline and at the end of treatment (week 4)
Copenhagen Neck Functional Disability Scale
Time Frame: Baseline and at the end of treatment (week 4)
Neck Functional Disability is a 15-item questionnaire. Total score(0-30) indicate higher disability
Baseline and at the end of treatment (week 4)

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 flexor endurance
Time Frame: Baseline and at the end of treatment (week 4)

The test protocol is performed with the individual in a supine position, with knees bent and soles of feet touching the ground (hook position). Individuals are asked to comfortably position their hands on their abdominal area.

During the procedure, the physiotherapist places their index and middle fingers overlapping under the participant's head. Participants are first instructed to pull their chin inward and downward (chin-tuck) and, while maintaining this position, to perform active craniocervical flexion, raising their head approximately 2.5 cm above the physiotherapist's fingers. The maximum time participants canmaintain this position without breaking it was recorded in seconds using a stopwatch.
Baseline and at the end of treatment (week 4)
SF-36 Quality of life
Time Frame: Baseline and at the end of treatment (week 4)
The SF-36 does not have a total scoring system; assessment is based on eight sub-dimensions: physical function, physical role difficulty, emotional role difficulty, social function, mental health, energy (vitality), pain, and general health perception.
Baseline and at the end of treatment (week 4)
Depression Scale
Time Frame: Baseline and at the end of treatment (week 4)
Beck Depression Scale is a psychological status-based scale consisting of 21 items developed to assess an individual's recent emotional state. Each item on the scale is scored between 0 and 3, and the level of depression is determined based on the total score obtained.
Baseline and at the end of treatment (week 4)

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.
Istanbul Rumeli University

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.
March 13, 2026

Primary Completion (Estimated)

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.
April 1, 2026

Study Completion (Estimated)

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.
April 30, 2026

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).
March 15, 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.
March 18, 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.
March 23, 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.
March 23, 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.
March 18, 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.
March 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.
  • IstanbulRumeliU-FTR-ENS-01

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

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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