Skip to main content
OpenTrials
Recruiting

NCT Number: NCT07725861

Strain Counter Strain With and Without Sustained Natural Aphophyseal Glide in Non Specific Neck Pain

Non-specific neck pain is a common problem that doesn't have a specific cause like an injury or disease. It usually includes neck pain, reduced movement, poor posture like forward head position, and some level of disability that can make daily activities difficult. Physiotherapists often use hands-on techniques like Strain Counterstrain (SCS) and SNAGs (Sustained Natural Apophyseal Glides) to help reduce pain, improve movement, and correct posture. This study aims to find out if adding SNAGs (Sustained Natural Apophyseal Glides) to the usual Strain Counterstrain (SCS) treatment helps more than SCS alone in patients with neck pain. We will measure changes in pain levels, neck movement, posture (craniovertebral angle), and daily life impact (NDI) over a four-week treatment program.

Recruiting

Interested in participating?

Request Info

Key information

Conditions

Cervical Pain Neck Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

18 year–60 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Ibne sina hospital and research institute.

Multan, Punjab Province, Pakistan

Location status: Recruiting

Location contact

Sajad Rashid, MS-OMPT

CONTACT

[email protected]

0300 6309825

About this study

This study will be a randomized clinical trial and will take place at Ibne Sina Hospital in Multan. Patients will be chosen using convenience sampling. Those who meet the required conditions will be randomly divided into two groups using a computer program. Group A will receive the SCS and SNAG technique , while Group B will receive SCS alone . Treatment will be given three times a week for four weeks The outcomes will be measured before and after the treatment. These include: Pain (measured using the NPRS Scale ,Neck movement (measured with a goniometer), Craniovertebral angle (checked using digital photos) ,Disability level (measured using the Neck Disability Index - NDI) . The collected data will be analyzed using SPSS version 21. First, the normality of the data will be checked using the Shapiro-Wilk test. Based on the results, suitable statistical tests will be used to compare the results within and between the groups.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • •Both Males and Females (20)
  • Age 18 and 60 years
  • pain intensity 3-6 rating on NPRS
  • Pain localized to cervical or upper trapezius

Exclusion criteria

  • • Cervical radiculopathy(20)
  • History of whiplash injury
  • History of cervical and thoracic spine surgery
  • Neck pain associated with vertigo(20)
  • History of spinal osteoporosis
  • Vertebral Fractures
  • Tumours
  • Diagnosed psychological disorders

Treatment and study plan

Strain Counterstrain + SNAG with Common Treatment

Other

Group A (Experimental Group) will receive both Strain Counterstrain (SCS) and SNAGs (30). They will attend 12 sessions in total, three times per week for four weeks. First, the SCS technique will be applied to the upper trapezius, levator scapulae, and scalene muscles. The patient will lie on their back or side while the therapist finds tender points and positions the neck to reduce tension, holding that position for 90 seconds before gently returning it to neutral and checking for pain. After this, SNAGs (Sustained Natural Apophyseal Glides) will be applied, targeting spinal segments like C2-C3 for rotation and C5-C6 for flexion or extension. While the patient sits upright, the therapist will apply a sustained glide on the vertebra as the patient moves the neck in the limited direction. Each movement will be repeated 6-10 times and followed by a reassessment

Strain Counterstain (SCS) only

Other

Group B (Control Group) will receive only the Strain Counterstrain (SCS) technique without SNAGs (31). The same neck muscles will be targeted, and the patient will lie in a similar position while the therapist identifies tender points and performs the SCS technique. No joint glides or mobilization will be applied in this group. Both groups will receive a total of 12 sessions over four weeks, with each session lasting about 40 minutes. Pre- and post-treatment assessments will be carried out to measure changes in pain (using NPRS/VAS), cervical ROM, craniovertebral angle (CVA), and neck-related disability (using the Neck Disability Index - NDI).

Primary outcomes

  1. Numeric pain rate scale (NPRS)

    Time frame: upto 4 weeks

    Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain".(25) NPRS shows strong construct validity and correlates well with other pain scales like the Visual Analog Scale (VAS) and McGill Pain Questionnaire. It is especially useful for tracking changes in pain over time.(13) The NPRS demonstrates excellent test-retest reliability with an intraclass correlation coefficient (ICC) of ~0.95 in patients with chronic musculoskeletal pain.(26) The MCID for NPRS is generally considered to be 2 points, meaning a change of 2 or more points is considered clinically meaningful in musculoskeletal pain patients

  2. Neck Disability index (NDI)

    Time frame: Upto 4 weeks

    This questionnaire will be used to assess disability. It comprises of 10 items; 7 related to daily living activities, 2 related to pain and 1 related to concentration. Each item is scored from 0 to 5. Total score is expressed as a percentage, with higher scores related to greater disability(28) Its construct validity has been supported through correlations with pain intensity, cervical range of motion, and quality-of-life measures (13). It shows excellent test retest reliability, with an ICC of 0.89-0.98 in patients with mechanical or non-specific neck pain (26)The Minimal Detectable Change (MDC) for NDI has been reported to be 5 points, while the MCID is commonly considered to be around 7-10 points for clinical relevance in chronic musculoskeletal pain

  3. Universal Goniometer (UG)

    Time frame: Upto 4 weeks

    It will measure range of motion of neck (29) A universal goniometer will be used to measure active cervical range of motion (CROM) in flexion, extension, lateral flexion, and rotation. This tool is portable, affordable, and easy to use in clinical and research settings.

    The validity of goniometry in measuring cervical ROM has been confirmed through comparisons with CROM devices and motion sensors, showing strong correlations (r > 0.85) in neck mobility measurement (27).

    Goniometer-based cervical ROM assessments demonstrate good to excellent reliability, with ICC values ranging from 0.79 to 0.96, depending on the plane of movement and rater experience

  4. Craniovertebral Angle (CVA)

    Time frame: Upto 4 weeks

    It is used to measure the degree of forward head posture, which is common in people with neck pain. A smaller CVA indicates a more forward head position, while a larger angle reflects a more neutral, healthy posture .To measure CVA, a lateral photograph is taken while the patient stands in a relaxed position. The angle is formed between a horizontal line passing through the C7 vertebra and a line connecting C7 to the tragus of the ear. This measurement is usually done using image analysis software or mobile applications like Posture Screen or ImageJ. Studies have shown that CVA measurement is a reliable and valid method for assessing head posture. It has good intra-rater and inter-rater reliability, with Intraclass Correlation Coefficients (ICC) ranging from 0.88 to 0.98 (8, 15).The Minimal Detectable Change (MDC) for CVA varies across studies but is generally estimated to be about 3-4 degrees, making it a sensitive tool for detecting postural improvements

Study contacts

Contact information is provided by the study sponsor or research team.

Amna Zia, PhD*

CONTACT

[email protected]

03244686993

Samrood Akram, PhD*

CONTACT

[email protected]

03324806143

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Effects of Strain Counter Strain With and Without Sustained Natural Aphophyseal Glide on Pain Range Of Motion ,Craniovertebral Angle and Disability in Patients With Non Specific Neck Pain

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jul 24, 2026
Registry last updated
Jul 24, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.