Comparison of Sustained Natural Apophyseal Glide &Amp; Instrument Assisted Soft Tissue Mobilization

The aim of this randomized controlled trial is to evaluate and compare the effectiveness of two therapeutic techniques-Cervical Sustained Natural Apophyseal Glide (SNAG) and Instrument-Assisted Soft Tissue Mobilization (IASTM)-in the treatment of mechanical neck pain. The trial seeks to determine which method is more effective in reducing pain, improving range of motion, and enhancing overall neck function in individuals suffering from mechanical neck pain.

: Mechanical neck pain refers to pain that originates from the structures of the neck, including muscles, ligaments, joints, or intervertebral discs. Mechanical neck pain has a lifetime prevalence of about 30% to 50% in the general adult population. At any given point in time, the prevalence of neck pain is estimated to be between 10% and 20%. It is often characterized by pain that worsens with specific neck movements or sustained postures and can be associated with muscle tightness, stiffness, or reduced range of motion. Although various muscles and joints around the cervical region can be affected but sternocleidomastoid and levator scapulae are one the commonly affected muscles, with lower cervical spine (C3-C7) being affected.

.Cervical SNAGs are a manual therapy technique that involves the application of sustained glides to the cervical spine while the patient performs specific movements. This technique is designed to address joint dysfunction, improve range of motion, and reduce pain .IASTM involves the use of specialized tools to apply controlled micro trauma to soft tissues, such as muscles, fascia, and tendons. This technique is used to address soft tissue dysfunction and improve tissue quality.

IASTM helps to break down scar tissue and adhesions that can form after injury or due to chronic poor posture, leading to improved tissue mobility and function. The controlled micro trauma induced by IASTM stimulates a localized inflammatory response, which promotes tissue repair and remodeling The technique enhances local blood circulation, bringing nutrients and oxygen to the affected area and aiding in the removal of metabolic waste products. The technique can modulate pain through mechanical stimulation of sensory receptors in the soft tissues, leading to pain relief. By addressing soft tissue restrictions, IASTM can help restore normal range of motion in the cervical spine. IASTM can be performed 2-3 times per week, depending on the severity of symptoms and patient response. Proper application of IASTM can help reduce muscle tension, improve range of motion, and alleviate pain in the levator scapulae and sternocleidomastoid muscles. Aftercare instructions, include hydration and avoiding immediate strenuous activity. The rationale for the use of Cervical SNAGs is to help to mobilize the facet joints of the cervical spine, which can become stiff due to poor posture, injury, or degenerative changes. he technique can alleviate pain by reducing joint stiffness and improving the alignment of the cervical vertebrae. By improving joint mobility, SNAGs can help normalize muscle function and reduce muscle spasms or tension. Patients perform active movements during SNAGs, which helps integrate the improved joint mobility into functional activities, leading to better outcomes in daily tasks. The technique enhances proprioceptive feedback from the cervical spine, helping patients achieve better neck posture and movement control. The rationale for the use of IASTM lies in breaking down scar tissue and adhesions, promoting tissue healing and remodeling, improving range of motion, reducing pain, enhancing blood flow and circulation, improving proprioception and neuromuscular control, non-Invasive and complementary approach.

Eligibility Criteria:
Inclusion Criteria:

* • Both genders (males and females)

  * Age between 20 and 45 years
  * History of neck pain \&gt;3 month, with tenderness on palpation present on sternocleidomastoid and Levator scapulae muscles and pain aggravated by activities involving turning head towards the side
  * Patients with pain on NPRS (at least 3)

Exclusion Criteria:

* • patients with recent injuries or surgeries in and around the neck region

  * Cervical nerve root lesion (radiculopathy)
  * Traumatic injuries like whiplash injury
  * malignancy in and around the neck region
  * rheumatoid arthritis
  * pregnant females
  * cervicogenic headache
  * Patients with unwillingness or inability to provide informed consent
  * Current participation in another neck pain treatment program