Effect of Sustained Natural Apophyseal Glides and Myofascial Release on Chronic Nonspecific Neck Pain: Randomized Controlled Trial

Main Article Content

Amal A. Morsi
Maher A. Al-kabalawy
Yasser M. Aneis
Mohamed S. Hamza
Hanaa K. Atta

Keywords

CNSNP, Manual therapy, SNAGs, MFR, combined effect

Abstract

Objectives: Considering the comparative effects of different therapeutic modalities on Chronic nonspecific neck pain (CNSNP), the combined and tangled treatment may significantly impact treatment programs. The study aimed to investigate the impacts of Mulligan’s sustained natural apophyseal glides (SNAGs) in combination with Myofascial release on pain, pain pressure sensitivity, functional disability, and range of motion (ROM) in CNSNP cases.
Methods: 54 cases diagnosed with CNSNP were assigned randomly to this clinical trial. Cases aged 20 to 45 years were allocated to either Group A, who obtained SNAGs, group B, who experienced MFR, or Group C, who got the combined intervention (SNAGs combined with MFR). This investigation evaluated the combined effects of SNAGs and MFR in CNSNP on pain intensity through the visual analog scale (VAS), Pain sensitivity through the pressure pain threshold (PPT), functional disability through the Neck Disability Index (NDI), and range of motion through a cervical range of motion instrument (CROM).
Results: There was a substantial decline in VAS, NDI, and a marked increase of PPT and neck ROM at post-treatment compared with pre-treatment in the three groups. According to the effects of the combined strategy, there was a statistical disparity in results concerning Pain pressure sensitivity, functional disability, and cervical ROM.
Conclusion: The findings of this study stressed the idea that the combined effect between SNAGs and myofascial releases was more effective and promising than the unimodal methodology.

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References

1. Abdelbaky, A. A., Hussein, H. M., & Raoof, N. A. A. (2019). Efficacy of SNAGs on dynamic balance level and pain intensity on chronic nonspecific low back pain. Lib.Pt.Cu.Edu.Eg, 6–7. Retrieved from http://lib.pt.cu.edu.eg/Amal A. Abdelbaky The 20th International Scientific Conference, 6-7 April, 2019 .pdf
2. Ali, A., Shakil-ur-Rehman, S., & Sibtain, F. (2014). The efficacy of Sustained Natural Apophyseal Glides with and without Isometric Exercise Training in Nonspecific Neck Pain. Pakistan Journal of Medical Sciences, 30(4), 872. https://doi.org/10.12669/pjms.304.5148
3. Altuğ Pamukkale Üniversitesifizik Tedavi ve Rehabilitasyon Yorektörlük Binası Giriş Katı, F., Kampusu Kınıklı, K., Duray, M., Şimşek, Ş., Altuğ, F., & Cavlak, U. (2018). Effect of proprioceptive training on balance in patients with chronic neck pain. Agri, 30(3), 130–137. https://doi.org/10.5505/agri.2018.61214
4. Arguisuelas, M. D., Lisón, J. F., Sánchez-Zuriaga, D., Martínez-Hurtado, I., & Doménech-Fernández, J. (2017). Effects of Myofascial Release in Nonspecific Chronic Low Back Pain. Spine. https://doi.org/10.1097/BRS.0000000000001897
5. Audette, I., Dumas, J. P., Côté, J. N., & De Serres, S. J. (2010). Validity and between-day reliability of the cervical range of motion (CROM) device. Journal of Orthopaedic and Sports Physical Therapy. https://doi.org/10.2519/jospt.2010.3180
6. Azemi-Xhakli, A., Gashi, A. I., & Marmullakaj, D. (2022). The Prevalence Of Chronic Nonspecific Neck Pain. Research in Physical Education, Sport & Health, 11(1).
7. Bernal-Utrera, C., Gonzalez-Gerez, J. J., Anarte-Lazo, E., & Rodriguez-Blanco, C. (2020). Manual therapy versus therapeutic exercise in nonspecific chronic neck pain: A randomized controlled trial. Trials. https://doi.org/10.1186/s13063-020-04610-w
8. Bhat, V., Patel, V., Eapen, C., Shenoy, M., PeerJ, S. M.-, & 2021, undefined. (n.d.). Myofascial release versus Mulligan sustained natural apophyseal glides’ immediate and short-term effects on pain, function, and mobility in nonspecific low. Peerj.Com. Retrieved from https://peerj.com/articles/10706/
9. Binder, A. I. (2008). Neck pain. BMJ Clinical Evidence. https://doi.org/10.1016/b978-044310361-2.50032-2
10. Boonstra, A. M., Schiphorst Preuper, H. R., Reneman, M. F., Posthumus, J. B., & Stewart, R. E. (2008). Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research. https://doi.org/10.1097/MRR.0b013e3282fc0f93
11. Bowler, N., Browning, P., & Lascurain-Aguirrebeña, I. (2017). The effects of cervical sustained natural apophyseal glides on neck range of movement and sympathetic nervous system activity. International Journal of Osteopathic Medicine. https://doi.org/10.1016/j.ijosm.2017.02.003
12. Bronfort, G., Haas, M., Evans, R., Leininger, B., & Triano, J. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic and Osteopathy. https://doi.org/10.1186/1746-1340-18-3
13. Cabrera-Martos, I., Rodríguez-Torres, J., López-López, L., Prados-Román, E., Granados-Santiago, M., & Valenza, M. C. (2020). Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial. Https://Doi.Org/10.1080/09593985.2020.1821418, 38(9), 1145–1152. https://doi.org/10.1080/09593985.2020.1821418
14. Carlesso LC, MacDermid JC, Santaguida LP. Standardization of adverse event terminology and reporting in orthopaedic physical therapy: application to the cervical spine. J Orthop Sports Phys Ther. 2010; 40: 455– 463.
15. Capuano-Pucci, D., Rheault, W., Aukai, J., Bracke, M., Day, R., & Pastrick, M. (1991). Intratester and intertester reliability of the Cervical Range of Motion device. Archives of Physical Medicine and Rehabilitation.
https://doi.org/10.5555/uri:pii:000399939190254G
16. Cerezo-Téllez, E., Torres-Lacomba, M., Mayoral-Del-Moral, O., Pacheco-Da-Costa, S., Prieto-Merino, D., & Sánchez-Sánchez, B. (2018). Health related quality of life improvement in chronic nonspecific neck pain: Secondary analysis from a single blinded, randomized clinical trial. Health and Quality of Life Outcomes. https://doi.org/10.1186/s12955-018-1032-6
17. Fredin, K, Practice, H. L.-M. S. and, & 2017, undefined. (n.d.). Manual therapy, exercise therapy or combined treatment in the management of adult neck pain–a systematic review and meta-analysis. Elsevier. Retrieved from https://www.sciencedirect.com/science/article/pii/S2468781217301170
18. Fredin, Ken, & Lorås, H. (2017). Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – A systematic review and meta-analysis. Musculoskeletal Science and Practice. https://doi.org/10.1016/j.msksp.2017.07.005
19. Genebra, C. V. D. S., Maciel, N. M., Bento, T. P. F., Simeão, S. F. A. P., & Vitta, A. De. (2017). Prevalence and factors associated with neck pain: a population-based study. Brazilian Journal of Physical Therapy, 21(4), 274–280. https://doi.org/10.1016/J.BJPT.2017.05.005
20. Gómez, F., Escribá, P., Oliva-Pascual-Vaca, J., Méndez-Sánchez, R., & Silvia Puente-González, A. (2020). Clinical Medicine Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. https://doi.org/10.3390/jcm9082580
21. Gugliotti, M., Tau, J., Gallo, K., Sagliocca, N., Horan, M., Sussman, N., & Wisnewski, R. (2020). Between-week reliability of the cervical range of motion (CROM) device for upper cervical rotation. Journal of Manual and Manipulative Therapy. https://doi.org/10.1080/10669817.2020.1805691
22. Hidalgo, B., Hall, T., Cagnie, B., & Pitance, L. (2016). The efficacy of manual therapy and exercise for treating nonspecific neck pain: An update of systematic reviews. Manual Therapy. https://doi.org/10.1016/j.math.2016.05.283
23. Hidalgo, B, Hall, T., Bossert, J., … A. D.-J. of back and, & 2017, undefined. (n.d.). The efficacy of manual therapy and exercise for treatingnonspecific neck pain: A systematic review. Content.Iospress.Com. Retrieved from https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr169615
24. Hidalgo, Benjamin, Hall, T., Bossert, J., Dugeny, A., Cagnie, B., & Pitance, L. (2017). The efficacy of manual therapy and exercise for treating nonspecific neck pain: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. https://doi.org/10.3233/BMR-169615
25. Hing, W., Hall, T., & Mulligan, B. (2019). The Mulligan Concept of Manual Therapy (textbook of techniques). Journal of Chemical Information and Modeling.
26. Hoy, D. G., Protani, M., De, R., & Buchbinder, R. (2010). The epidemiology of neck pain. Best Practice and Research: Clinical Rheumatology. https://doi.org/10.1016/j.berh.2011.01.019
27. Hussein, H. M., Morsi, A. A., & Abdelraoof, N. A. (2021). The immediate effect of sustained natural apophyseal glide on postural stability and pain in individuals presenting with flexion-dominant chronic low back pain: A randomized single-blinded placebo-controlled trial. Journal of Back and Musculoskeletal Rehabilitation, 34(6). https://doi.org/10.3233/BMR-200217
28. Jang, H., Kim, H., of, C. S.-J. of the korean society, & 2011, undefined. (2011). The effects of combined exercise program for patients with chronic neck pain. Koreascience.or.Kr, 6(1), 81–92. Retrieved from https://www.koreascience.or.kr/article/JAKO201117463443688.page
29. Konstantinos, Z. (2018). The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain. Journal of Novel Physiotherapy and Rehabilitation, 022–035. https://doi.org/10.29328/JOURNAL.JNPR.1001018
30. López-De-Uralde-Villanueva, I., Notario-Pérez, R., Del Corral, T., Ramos-Díaz, B., Acuyo-Osorio, M., & La Touche, R. (2017). Functional limitations and associated psychological factors in military personnel with chronic nonspecific neck pain with higher levels of kinesiophobia. Work, 58(3), 287–297. https://doi.org/10.3233/WOR-172634
31. Macdelilld, J. C., Walton, D. M., Avery, S., Blanchard, A., Etruw, E., Mcalpine, C., & Goldsmith, C. H. (2009). Measurement properties of the neck disability index: A systematic review. In Journal of Orthopaedic and Sports Physical Therapy. https://doi.org/10.2519/jospt.2009.2930
32. Modarresi, S., Lukacs, M., Pain, M. G.-… J. of, & 2022, undefined. (n.d.). A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain. Journals.Lww.Com. Retrieved from https://journals.lww.com/clinicalpain/Fulltext/2022/02000/A_Systematic_Review_and_Synthesis_of_Psychometric.8.aspx
33. Phillips, K. M., Houssein, F. A., Speth, M. M., & Sedaghat, A. R. (2022). Utility of Visual Analog Scale of Subdomain Scores of the 22-Item Sinonasal Outcome Test in Chronic Rhinosinusitis. Otolaryngology - Head and Neck Surgery (United States), 167(2), 391–394. https://doi.org/10.1177/01945998211068748
34. Reid, S. A., Callister, R., Katekar, M. G., & Rivett, D. A. (2014a). Effects of Cervical Spine Manual Therapy on Range of Motion, Head Repositioning, and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 95(9), 1603–1612. https://doi.org/10.1016/J.APMR.2014.04.009
35. Reid, S. A., Callister, R., Katekar, M. G., & Rivett, D. A. (2014b). Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2014.04.009
36. Rezkallah, S. S., & Abdullah, G. A. (2018). Comparison between sustained natural apophyseal glides (SNAG’s) and myofascial release techniques combined with exercises in non specific neck pain. Physiotherapy Practice and Research. https://doi.org/10.3233/PPR-180116
37. Saadat, M., Salehi, R., Negahban, H., Shaterzadeh, M. J., Mehravar, M., & Hessam, M. (2018). Postural stability in patients with nonspecific chronic neck pain: A comparative study with healthy people. Medical Journal of the Islamic Republic of Iran. https://doi.org/10.14196/MJIRI.32.33
38. Safiri, S., Kolahi, A. A., Hoy, D., Buchbinder, R., Mansournia, M. A., Bettampadi, D., … Ferreira, M. L. (2020). Global, regional, and national burden of neck pain in the general population, 1990-2017: Systematic analysis of the Global Burden of Disease Study 2017. The BMJ. https://doi.org/10.1136/bmj.m791
39. Saleem, I., Zahoor, I., Rana, A., … S. S.-P. J. of, & 2022, undefined. (2022). Apophyseal Glideand Natural Apophyseal Glide Effects on Pain, Range of Motion and Neck Disability in Patients with Chronic Neck Pain: Comparison of Sustained …. Thejas.Com.Pk. https://doi.org/10.54393/pjhs.v3i04.147
40. Scariati, P. “Myofascial release concepts. ” In DiGiovanna E. (Ed.). An Osteopathic Approach to Diagnosis and Treatment. London: Lippincott, 1991
41. Shacklock M: Clinical neurodynamics: a new system of musculoskeletal treatment, Edinburgh, 2005,Butterworth Heinemann Elsevier.
42. Shaheen, A. A. M., Omar, M. T. A., & Vernon, H. (2013). Cross-cultural adaptation, reliability, and validity of the arabic version of neck disability index in patients with neck pain. Spine. https://doi.org/10.1097/BRS.0b013e31828b2d09
43. Siu, E. H. K., & Chiu, T. T. W. (2013). The relationship between cervical range of motion, head-repositioning accuracy, and postural stability in healthy adults. International Journal of Therapy and Rehabilitation. https://doi.org/10.12968/ijtr.2013.20.1.9
44. Tousignant, M., & Breton, A. (2006). Range of Motion ( CROM ) Device for Rotational Range of Motion on Healthy. Journal of Orthopaedic & Sport Physical Therapy.
45. Tozzi, P., Bongiorno, D., & Vitturini, C. (2011). Fascial release effects on patients with nonspecific cervical or lumbar pain. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2010.11.003
46. Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy. https://doi.org/10.1016/j.math.2007.06.003
47. Vernon, H., & Mior, S. (1991). The neck disability index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics.
48. Vignesh Bhat, P., Patel, V. D., Eapen, C., Shenoy, M., & Milanese, S. (2021). Myofascial release versus Mulligan sustained natural apophyseal glides’ immediate and short-Term effects on pain, function, and mobility in nonspecific low back pain. PeerJ, 9, e10706. https://doi.org/10.7717/PEERJ.10706/SUPP-3
49. Vincent, K., Maigne, J. Y., Fischhoff, C., Lanlo, O., & Dagenais, S. (2013). Systematic review of manual therapies for nonspecific neck pain. Joint Bone Spine. https://doi.org/10.1016/j.jbspin.2012.10.006
50. Walton, D. M., Levesque, L., Payne, M., & Schick, J. (2014). Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables. Physical Therapy, 94(6), 827–837. https://doi.org/10.2522/ptj.20130369
51. Wang, S. Q., Jiang, A. Y., & Gao, Q. (2022). Effect of manual soft tissue therapy on the pain in patients with chronic neck pain: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 49, 101619. https://doi.org/10.1016/J.CTCP.2022.101619
52. Young, B. A., Walker, M. J., Strunce, J. B., Boyles, R. E., Whitman, J. M., & Childs, J. D. (2009). Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine Journal. https://doi.org/10.1016/j.spinee.2009.06.002
53. Zakaria, H., Badawy, W., & Ali, O. (2017). Effect of craniocervical flexion training on postural stability in patients with cervical degenerative disc disease: A randomized controlled trial. International Journal of Therapies and Rehabilitation Research. https://doi.org/10.5455/ijtrr.000000238
54. Zutshi, K., Verma, P., & A. H.-I. J. of P., & 2021, undefined. (n.d.). Effectiveness of Myofascial Release in Improving Pain, Pain Pressure Threshold and Disability as Compared with Standard Care in Upper Trapezius Myofascial. Ijpot.Com. Retrieved from http://www.ijpot.com/scripts/IJPOT_July-Sept.2021.pdf#page=43