Proprioceptive Neuromuscular Facilitation And Passive Vertebral Mobilization For Neck Disability In Patients With Mechanical Neck Pain

Mechanical neck pain is a common musculoskeletal condition often caused by poor posture, repetitive stress, or mechanical strain involving cervical joints, ligaments, and muscles. It is typically localized and not associated with radiating symptoms. This condition leads to functional disability, reduced cervical range of motion (ROM), and increased pain, significantly affecting individuals' quality of life and work productivity. While various physiotherapeutic approaches are employed in its management, the comparative efficacy of Proprioceptive Neuromuscular Facilitation (PNF) and Passive Vertebral Mobilization (PVM) remains inadequately explored in controlled settings.

This randomized controlled trial aimed to evaluate and compare the effectiveness of PNF and PVM techniques in improving neck-related disability, reducing pain, and enhancing active cervical ROM in individuals diagnosed with mechanical neck pain. The study was conducted at the University of Lahore Teaching Hospital and followed ethical approval and informed consent protocols. The trial design was single-blinded, with the assessor unaware of group allocation.

A total of 62 participants aged 18-35 years with clinically diagnosed mechanical neck pain of at least 4 weeks duration were included using purposive sampling. Participants were randomly allocated (via lottery method) into two equal groups (n = 31 per group): Group A received PNF techniques, and Group B received Maitland-based passive vertebral mobilization.

Group A (PNF) intervention involved rhythmic initiation, dynamic reversals, and contract-relax patterns performed across diagonal cranio-cervical movement patterns. Group B (PVM) received graded Maitland mobilizations (Grades I-IV) targeting the cervical vertebrae. Both groups received physiotherapy three times per week for four consecutive weeks. Each treatment session lasted 15-30 minutes.

Outcome measures were recorded at baseline, week 2, and week 4 and included:

Neck Disability Index (NDI): to assess functional limitation

Numeric Pain Rating Scale (NPRS): to measure subjective pain intensity

Active Cervical Range of Motion (ACROM): measured using a goniometer

Statistical analysis using SPSS Version 24 revealed that both groups experienced statistically significant improvements over time in all outcome measures:

NDI (F = 355.163, p < .001)

NPRS (F = 544.090, p < .001)

ACROM (F = 33.413, p < .001)

Between-group comparisons showed no significant difference for NDI (p = .769) or ACROM (p = .987). However, PNF demonstrated significantly greater pain reduction at baseline (p = .039) and at week four (p = .043), suggesting superior short-term analgesic effects.

This trial demonstrated that both PNF and PVM are effective in reducing neck disability and improving cervical mobility and pain. PNF may offer enhanced short-term pain relief due to its neuromuscular activation mechanisms, while PVM remains an effective passive intervention for joint mobilization.

The study's findings provide clinicians with evidence supporting both interventions, allowing treatment selection based on individual patient presentation, therapist skill, and rehabilitation goals. Future studies with larger samples and longer follow-up periods are recommended to assess long-term efficacy, retention of benefits, and cost-effectiveness.

Inclusion criteria

• Participants aged between 18 and 35 years were included in the study (Ashfaq et al., 2022).
• Participants diagnosed with pain localized in the neck region for at least 4 weeks were included.
• Participants diagnosed with no radiating pain beyond the shoulder or fingers were included (Cohen, 2015).
• Participants diagnosed with no identified neurological deficits were included.
• Participants having no history of major trauma or surgery to the cervical spine were included (Rodríguez-Huguet et al., 2020).

Exclusion criteria

• Participants who were diagnosed with ankylosing spondylitis, rheumatoid arthritis, fracture of spine, cancer or congenital anomaly of the cervical spine, positive neurological findings (Ashfaq et al., 2022).
• Patients with any other contraindication to manual therapy (Ashfaq et al., 2022).
• Neurological conditions affecting the cervical spine.
• Uncontrolled dizziness or vertigo (Cohen, 2015).
• Known malignancy or any pregnancy (Cohen, 2015).
• Current use of medications that could affect pain perception (e.g., opioids, high-dose antidepressants) (Rodríguez-Huguet et al., 2020)