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

Enrolling by invitation

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • 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

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
Intervention / Treatment
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

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

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

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)

March 13, 2026

Primary Completion (Estimated)

April 1, 2026

Study Completion (Estimated)

April 30, 2026

Study Registration Dates

First Submitted

March 15, 2026

First Submitted That Met QC Criteria

March 18, 2026

First Posted (Actual)

March 23, 2026

Study Record Updates

Last Update Posted (Actual)

March 23, 2026

Last Update Submitted That Met QC Criteria

March 18, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID 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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