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Completed

NCT Number: NCT07403279

Sustained Natural Apophyseal Glides With and Without Integrated Neuromuscular Inhibition Technique in Neck Pain

The study was conducted to determine the effects of Sustained Natural Apophysial Glide with and without Integrated Neuromuscular Inhibition Technique on pain, range of motion and function in patients with chronic mechanical neck pain

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Key information

Conditions

Chronic Mechanical Neck Pain Neck Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Lahore General Hospital,Lahore

Lahore, Punjab Province, Pakistan

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Age ranged from 18 to 45 years and both genders.
  • Patient having neck-pain symptoms for more than 3 months duration.
  • Spurling test, distraction test, upper limb tension test and shoulder abduction test negative upon assessment.
  • The participants should have MTrPs in any one of these following cervical muscles which include levator scapulae, upper trapezius, splenius capitis and sternocleidomastoid muscles which may be active or latent.
  • A score greater than twenty percent on NDI.
  • Jump Sign when pressure is applied.
  • Positive Simons criteria which contains following these 5 characteristics :(1) Pain on palpation (2) pain that is radiating (3) Tightened cord like structure in muscle fiber that is detectable upon palpation(4) Reduced Flexibility of that muscle (5) 'twitching response' on needling.
  • Participants who described pain which is felt between spinous process of 1st thoracic vertebrae and superior nuchal line in posterior or posterolateral part of neck

Exclusion criteria

  • Recent fracture, trauma (whiplash injury) and surgery in and around the shoulder and neck
  • Neural disorders due to prolapsed intervertebral disc
  • Carcinoma, Heart diseases, Metabolic disease in bone and joints
  • Patients having history of osteoporosis, prolong steroid and analgesics use
  • Unstable spine and open sores, Localized infection in neck
  • Vertebrobasilar insufficiency.
  • Cervical radiculopathy and myelopathy

Treatment and study plan

sustained natural apophyseal glides

Other

SNAGs were applied in three sets, with repetitions progressively increased from 6 to 10 over a period of four weeks, administered three times per week.

Integrated Neuromuscular Inhibition technique

Other

The integrated neuromuscular inhibition technique comprised three steps: ischemic compression, strain-counterstrain technique, and muscle energy technique. The technique was applied to the upper trapezius, levator scapulae, sternocleidomastoid, and splenius capitis muscles. Muscle selection was based on palpatory examination performed prior to each treatment session. Each treatment session lasted 10 minutes, during which all three steps were repeated three times within a single session. The intervention was delivered three times per week for four weeks, resulting in a total of 12 treatment sessions.

Standardized Physiotherapy Treatment

Other

Standardized physiotherapy included the application of an electrical hot pack at moderate intensity for 10 minutes. Transcutaneous electrical nerve stimulation (TENS) delivered in continuous mode at a frequency of 100 Hz for 15 minutes. Passive stretching was performed for cervical muscles prone to tightness, including the levator scapulae, sternocleidomastoid, upper trapezius, and scalene muscles, with a 30-second hold, three sets of ten repetitions, and a one-minute rest between sets. Scapular stabilization exercises, comprising shoulder shrugging and scapular retraction, were performed for 15 repetitions with a 6-second hold. Neck isometric exercises were repeated ten times with a 6-second hold. Cervical stabilization exercises were performed in two sets of ten repetitions per session, with each repetition held for ten seconds, a forty-second rest between repetitions, and a two-minute rest between sets.

Primary outcomes

  1. Numeric Pain Rating Scale

    Time frame: From enrollment to end of treatment at 4th weeks

    Numeric Pain Rating Scale is utilized to evaluate pain.This is a scale between 0 and 10 where 0 denotes no pain and 10 denotes the worst pain whereas 1-3 denotes mild pain 4-6 denotes moderate pain and 7-10 denotes severe pain.

Secondary outcomes

  1. Neck Disability Index

    Time frame: From enrollment to the end of treatment at 4th weeks

    The Neck Disability Index is a self-reported questionnaire used to assess neck-related functional disability. It consists of 10 items addressing pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is scored on a 6-point scale (0-5), with a total score ranging from 0 to 50, where higher scores indicate greater disability. Scores are categorized as no disability (0-4), mild disability (5-14), moderate disability (15-24), severe disability (25-34), and complete disability (≥35).

  2. Range of Motion Cervical Spine (Flexion)

    Time frame: From enrollment to the end of treatment at 4th week.

    Changes in cervical spine flexion range of motion at baseline and 4th week of intervention was measured using goniometer

  3. Range of Motion Cervical Spine (Extension)

    Time frame: From enrollment to the end of treatment at 4th week

    Changes in cervical spine extension range of motion at baseline and 4th week of intervention was measured using goniometer.

  4. Range of Motion Cervical Spine (Lateral Flexion) Right Side

    Time frame: From enrollment to the end of treatment at 4th week

    Changes in cervical spine lateral flexion on right side range of motion at baseline and 4th week of intervention was measured using goniometer.

  5. Range of Motion Cervical Spine (Lateral Flexion) Left Side

    Time frame: From enrollment to the end of treatment at 4th week

    Changes in cervical spine lateral flexion on left side range of motion at baseline and 4th week of intervention was measured using goniometer.

  6. Range of Motion Cervical Spine (Rotation) Right Side

    Time frame: From enrollment to the end of treatment at 4th week

    Changes in cervical spine rotation on right side range of motion at baseline and 4th week of intervention was measured using goniometer

  7. Range of Motion Cervical Spine (Rotation) Left Side

    Time frame: From enrollment to the end of treatment at 4th week

    Changes in cervical spine rotation on left side range of motion at baseline and 4th week of intervention was measured using goniometer

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Effects of Sustained Natural Apophyseal Glides With and Without Integrated Neuromuscular Inhibition Technique on Pain, Range of Motion, and Function in Patients With Chronic Mechanical Neck Pain

Important dates

Study start
2025
Primary completion
2025
Study completion
2025
First posted
Feb 11, 2026
Registry last updated
Feb 11, 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.

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