Effect of Sustained Natural Apophyseal Glide Combined With Strengthening Exercises of Lower Fibers of Trapezius in Patient With Unilateral Neck Pain

Neck pain is considered one of the very common cause behind musculoskeletal pain and is 4th leading cause of disability . Cervical pain is among 5 most contributing factors in causing years lived with disability.Individuals with unilateral neck pain exhibit significantly less Lower Trapezius strength than Middle and Upper Trapezius fibers .Mulligan is one of the mobilization techniques that can be applied in case of neck pain.In prolong neck pain there is a hyperactivation and shortening of upper trapezius which makes the lower trapezius weak this leads to imbalance between cervical and scapular muscles and result in impaired biomechanics. So mostly treatment focused on upper trapezius and neglecting the lower trapezius and this create increase chances of recurrency of neck pain because the imbalance remains present. So, this study aims at evaluating the effects of SNAGS combined with strengthening exercises of lower fibers of trapezius .

Study Overview

• Status: Active, not recruiting
• Conditions: Neck Pain
• Intervention / Treatment: Procedure: Conventional Physical Therapy; Procedure: SNAG'S; Procedure: Strengthening Exercise

• Study Type: Interventional
• Enrollment (Estimated): 38
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46000
      • Foundation University College of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Individuals aged 18-35 years
• Both gender
• Unilateral neck pain
• Symptoms of duration more than 3 months.
• NPRS scoring of greater than or equal to 4 points.
• Neck disability index score of 20% or above.
• Manual muscle testing : grade 3

Exclusion Criteria:

• Prior cervical and thoracic spine fractures, dislocations, or surgeries, spinal osteoporosis or infection, or whiplash.
• Any trauma or localized infection in neck region
• Psychiatric diseases such as phobia/obsession and depression

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SNAGS + Conventional PT Group; Participants of this group receive conventional physical therapy.Hot pack and tens ( 10 min each); Sustained natural apophyseal glides to painful or restricted movement; 4 sets of 4 repetition per session; Strengthening of deep neck flexor	Procedure: Conventional Physical Therapy; It will comprise of hot pack for 10 minutes, TENs at 80-100 Hz over trapezius for 10 minutes.Strengthening of deep neck flexors; Procedure: SNAG'S; Sustained natural apophysial glides will consist of frequency: 4 sets of 3-5 repetition per session for 2 weeks
Experimental: SNAGS+Strengthening of lower fibers trapezius+Conventional PT Group; Participants of this group receive conventional physical therapy. It will comprise of hot pack for 10 minutes, TENs at 80-100 Hz over trapezius for 10 minutes.; Sustained natural apophyseal glides to painful or restricted movement.4 sets of 3-5 repetition per session.; Strengthening of deep neck flexors; Then strengthening exercises of lower fibers of trapezius	Procedure: Conventional Physical Therapy; It will comprise of hot pack for 10 minutes, TENs at 80-100 Hz over trapezius for 10 minutes.Strengthening of deep neck flexors; Procedure: SNAG'S; Sustained natural apophysial glides will consist of frequency: 4 sets of 3-5 repetition per session for 2 weeks; Procedure: Strengthening Exercise; Strengthening exercises of lower fibers of trapezius

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ROM	Cervical ROM will be measured through CROM device	2 weeks
Level of Neck Disability	Neck Disability Index will be used to measure level of neck disability	2 weeks
Muscle strength	MMT for Lower fibers of trapezius	2 weeks
Pain intensity	Pain will be measured on the basis of Numeric Pain Rating Scale score.It is rated on 0-10 scale in which 0 means no pain and 10 means the maximum possible pain	2 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2024
• Primary Completion (Estimated): December 10, 2024
• Study Completion (Estimated): December 30, 2024

Study Registration Dates

• First Submitted: October 30, 2024
• First Submitted That Met QC Criteria: October 30, 2024
• First Posted (Actual): October 31, 2024

Study Record Updates

• Last Update Posted (Estimated): November 20, 2024
• Last Update Submitted That Met QC Criteria: November 18, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: FUI/CTR/2024/45

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No