Effect of Mulligan Snag and Diaphragmatic Release on Thoracic Kyphosis

Study Overview
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Brief Summary
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the aim of this study is to investigate the efficacy of mulligan snag mobilisation and diaphragmatic release on upper crossed syndrome

Detailed Description
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Acquired postural disorders can be a consequence, to a large extent, of contemporary living and working conditions. Some of the most typical factors include continuous use of mobile phones and computers, working in sedentary jobs. Prolonged incorrect posture and reduced physical activity present a dis-balance in the musculature . It can also lead to vision issues, as well as headaches, musculoskeletal issues, and pain, as well as a multitude of other symptoms. Upon the available research studies, there is not study conducted to investigate the effect of mulligan SNAG mobilization and diaphragmatic release in upper crossed syndrome patients this trial has four groups; one will receive diaphragmatic release + conventional, the second will receive mulligan SNAG mobilization, and conventional, the third will receive mulligan SNAG mobilization+diaphragmatic release+conventional, the fourth subjects will receive conventional

Official Title
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Effect of Mulligan Snag and Diaphragmatic Release on Thoracic Kyphosis

Conditions
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Postural Kyphosis, Cervicothoracic Region

Intervention / Treatment
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* Other: mulligan snag mobilization and diaphragmatic release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ranged from 17 to 22 years . Body Mass Index from 20 to 25 kg/m² . All participants have an intensity of neck pain on VAS (4-8) (moderate cases) . The subjects were chosen from both sexes. All participants have kyphosis angle ≥42° All participants have mechanical neck pain and FHP (craniovertebral angle CVA < 49) CVA of < 49) . Exclusion Criteria: Malignancy Fractures of the cervical spine Cervical radiculopathy or myelopathy Vascular syndromes such as vertebrobasilar insufficiency Rheumatoid arthritis Neck or upper back surgery Taking anticoagulants Local infection Whiplash injury

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 22 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: EFFECT OF MULLIGAN SNAG MOBILISATION AND DIAPHRAGMATIC RELEASE
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: diaphragmatic release, and conventional<br>Diaphragmatic release: The patients will be positioned in the supine position. The therapist stood at the head of the patient. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and the last three fingers. During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally, while elevating the ribs simultaneously. During exhalation, the therapist will deepen hand contact toward the inner coastal margins for 5 to 7 minute conventional therapy: the patient will receive chin-in, interscapular exercises, and pectoralis stretch | Other: mulligan snag mobilization and diaphragmatic release<br>* The patients will be in the supine position. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ). During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally. During exhalation, the therapist will deepen hand contact toward the inner coastal margins. mulligan snag, Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement<br>|
| Experimental: mulligan SNAG mobilization, and conventional<br>mulligan snag: Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement and then sustains it at the end range position for a few seconds. (3 sets,10 repetitions) conventional therapy: the patient will receive chin-in, interscapular exercises, and pectoralis stretch | Other: mulligan snag mobilization and diaphragmatic release<br>* The patients will be in the supine position. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ). During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally. During exhalation, the therapist will deepen hand contact toward the inner coastal margins. mulligan snag, Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement<br>|
| Experimental: mulligan SNAG mobilization, diaphragmatic release, and conventional<br>Diaphragmatic release: The patients will be positioned in the supine position. The therapist stood at the head of the patient. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and the last three fingers. During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally, while elevating the ribs simultaneously. During exhalation, the therapist will deepen hand contact toward the inner coastal margins. (5 to 7 minutes) mulligan snag: Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement and then sustains it at the end range position for a few seconds(3 sets,10 repetitions) conventional therapy: the patient will receive chin-in, interscapular exercises, and pectoralis stretch | Other: mulligan snag mobilization and diaphragmatic release<br>* The patients will be in the supine position. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ). During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally. During exhalation, the therapist will deepen hand contact toward the inner coastal margins. mulligan snag, Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement<br>|
| Active Comparator: the conventional therapy<br>the patient will receive chin-in, inter-scapular exercises, and pectoralis stretch (3 sets,10 repetitions) | Other: mulligan snag mobilization and diaphragmatic release<br>* The patients will be in the supine position. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ). During the patient's inspiration, the therapist will gently pull the points of hand contacts toward the head and slightly laterally. During exhalation, the therapist will deepen hand contact toward the inner coastal margins. mulligan snag, Apply a passive intervertebral movement in a superior anterior direction along the facet plane. While maintaining this glide as the patient actively moves in any range of physiological movement<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | The scale that will be used is the Visual analogue scale;each subject will be instructed to put point on a line from no pain to tolerable pain | up to four weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cervical range of motion | theCROM device will placed on patient's head while he/she seated and looking forward the difference between the ponter value and the value after movement will be recorded as the motion angle of the cervical vertebrae | up to four weeks |