Effect of Sustained Natural Apophseal Glides and Myofascial Release on Chronic Non-specific Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      The aim of investigator's study is to combine and compare the two scientifically approved
      therapies for the CNSNP to investigate the short term and mid-term changes of the combination
      of these two manual techniques concerning pain, function, range of motion ROM and postural
      stability.
    

Detailed description: 
      Neck pain NP is a recognized medical and socioeconomic problem, which is responsible for high
      treatment costs, sick leave, and individual suffering, in addition to being one of the main
      reasons for people to seek health care services .NP is widely spread in healthcare centers
      with a prevalence estimation of 288.7 million, in North Africa and the Middle East ranged
      between 3917.7 to 5022.4 per 100 000 populations in 2017. NP with symptoms duration exceeding
      12 weeks is considered chronic.

      Individuals who have chronic non-specific neck pain CNSNP have less quality of life, and more
      pain interference in their life. More over studies showed that patients with CNSNP subjects
      have poorer postural control than healthy subjects.

      Alteration of the proprioception of the neck muscles and joints that play a master role in
      the cervical joint position and motor control of the head could be the primary cause of CNSNP
      . Studies have evaluated the effect of different manual techniques in cases of CNSNP checking
      mainly usefulness and effectiveness of these interventions on this clinical condition.
      However, there is less evidence in literature investigating the short and mid-term changes of
      these techniques.

      Manual therapy, is a physical treatment primarily used by physical therapists, occupational
      therapists, manipulative therapy to treat musculoskeletal pain and disability; it is most
      commonly includes kneading , manipulation of the muscles and mobilization of joints .Many
      Studies investigating the effectiveness of manual therapies on CNSNP ,proving reduction of
      spinal excitability and pain sensitivity, enhancement of function and range of motion.

      Brian Mulligan techniques are widely used for joint dysfunction by growing number of
      therapists and are an important addition to the field of Manual Therapy. Literature reveals
      many and diverse treatment approaches for chronic neck pain. Sustained natural apophyseal
      glides SNAGs are pain free spinal manual therapy treatment techniques involving concurrent
      accessory joint gliding and active physiological movement, with overpressure at end range,
      which are utilized for painful movement restrictions of the spine.

      Mulligan's SNAGs is one of the most statistically proved in many studies that manual therapy
      technique affects proprioception, function, range of motion, pain.

      On the other hand, Myofascial release which is a form of soft tissue therapy that is intended
      to reduce pain and increase mobility in patients that are suffering from chronic pain
      conditions. Myofascial release has shown effectiveness in reducing mechanical neck pain and
      in improving functional abilities by freeing restrictions of movement that originate in the
      soft tissues of the body.

      Furthermore, as the focus of most previous studies has been to examine compare mulligan's
      SNAGs and Myofascial release separately, studies on their combination effects have been
      largely ignored. Both two techniques have shown efficacy, but since SNAGS and Myofascial
      release are different mechanisms of action, the time of their effects and their progression
      could be different.

      The aim of investigators' study is to combine and compare the two scientifically approved
      therapies for the CNSNP to investigate the short term and mid-term changes of the combination
      of these two manual techniques concerning pain, function, range of motion ROM and postural
      stability.
    

Intervention name(s): combined effect
Intervention type(s): Other
Intervention description(s): Compare the short- and mid-term effects of Mulligan's SNAGs, Myofascial release, and their combination on pain intensity, pain pressure sensitivity, cervical function, range of motion (ROM) and postural stability in CNSNP patients
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Design of the study:
Single-blinded randomized controlled trial design. Patients will be randomly assigned into 3 equal groups using the statistical package for social science (SPSS 20).
Group A (Mulligan's SNAGs) Group B (Myofascial release) Group C (Mulligan's SNAGs + Myofascial release)
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: CNSNP; SNAGs; MFR