Sustained Natural Apophyseal Glides Research Articles

The effects of lumbar self-sustained natural apophyseal glides on lumbar spine range of motion and hip muscle flexibility in asymptomatic college students: a crossover study

Background: Patients with low back pain (LBP) tend to have prolonged treatment periods, which increase the cost of medical care. Several studies have reported that lumbar spine range of motion (ROM) and hip muscle flexibility are factors in LBP. Sustained natural apophyseal glides (SNAGs) have reportedly improved the lumbar spine ROM and hip flexibility of LBP patients. Moreover, self- SNAGs can be performed by the patients themselves. Aim: This study aimed to evaluate the short-term effects of self-SNAGs on lumbar spine ROM compared to a repeated movement procedure in asymptomatic college students. Methods: A prospective crossover study was conducted on 14 asymptomatic male college students. The asymptomatic participants performed self-SNAGs or repeated movements (i.e., three sets per day, 6 times a day over 1 week), and the compliance rate for both exercises was recorded. The lumbar spine ROM (i.e., flexion, extension, lateral bending, and rotation) was measured using the back ROM instrument, and hip muscle flexibility was measured using the Thomas test, heel-buttock distance, finger-floor distance, and straight leg raise test (SLR). Measurements were taken before commencement, immediately after, and 1 week later. Results: Left lateral bending and left SLR were excluded from the between-group comparison (self- SNAG and sham) due to a carryover effect (P < 0.05). A comparison between the self-SNAG and sham groups displayed no significant differences in the lumbar spine ROM and hip muscle flexibility (P > 0.05). Conclusion: Our study revealed that lumbar self-SNAGs had no significant effect on lumbar spine ROM or hip muscle flexibility in the short term, suggesting that such movements should be avoided when stretching to prevent LBP. However, this study did not include subjects with limited lumbar spine ROM and hip muscle flexibility due to pain, warranting further validation in future studies. Relevance for Patients: The effects of lumbar self-SNAGs were similar to that of sham exercises in healthy individuals without joint ROM restrictions in the trunk or lower extremities due to LBP

Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

ABSTRACT Purpose To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. Methods Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). Results After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). Conclusion Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

Effects of sustained natural apophyseal glides versus rocabado 6 × 6 program in subjects with cervicogenic headache

BackgroundCervicogenic headache is designated as the most common type of secondary headache that results from conditions affecting the neck’s bony components, muscles, and intervertebral discs rather than the head itself.ObjectiveThe purpose was to determine the effects of Sustained Natural Apophyseal Glides (SNAGs) versus the Rocabado 6 × 6 program in subjects with cervicogenic headaches.MethodsThis study was a randomized clinical trial. The sample size was 38, and participants aged 20–60 years (mean age 40.22 ± 9.66) suffering from cervicogenic headaches were randomly allocated using the lottery method into two groups with 19 participants in each group. Assessment of subjects was done before starting treatment and by the end of the 8th week for all the variables. Outcome measures were the Neck Disability Index (NDI), 6-item Headache Impact Test (HIT-6), Flexion-Rotation test (FRT) to assess the rotation range of motion at the level of C1-C2 (goniometer) and the Numeric Pain Rating Scale (NPRS) for the intensity of pain. Data analysis was done by SPSS (IBM) 25. To check the normality of the data the Shapiro-Wilk test was used.ResultsIn the Shapiro-Wilk test p-value of all the testing variables i.e. NDI, HIT-6 score, FRT and NPRS was > 0.05, data was normally distributed and parametric tests were used. Group A showed a considerable improvement (p < 0.05) in all variables compared to Group B, while within-group analysis of both groups shows that all outcome measures show significant results (p < 0.05).ConclusionIt was concluded that both SNAGs and Rocabado’s 6 × 6 exercises were effective for the treatment of cervicogenic headache but the effects of headache SNAG were superior and produced more improvement in intensity of headache, disability, frequency of headache, duration of headache as compared to Rocabado 6 × 6 exercises.Trial registration numberThis study was registered at ClinicalTrials.gov ID: NCT05865808 on date 19/05/2023.

Effectiveness of mid thoracic spine mobilization on postural balance and gait ability in subacute stroke patients: A randomized clinical trial.

Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. Fifty subacute stroke patients were randomly allocated to the SNAG (n= 17), MM (n= 16), and control (n= 17) groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p< 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques.

Effects of Neurodynamics Versus Neurodynamic Sustained Natural Apophyseal Glide in Lumbosacral Radiculopathy

Lumbosacral radiculopathy is a frequently reported health issue in middle-aged people, with a prevalence varying fromabout 2.2% to 8%. Neurodynamic mobilization (NM) and Neurodynamic sustained natural apophyseal glide (N-SNAG) techniqueswere proven effective for Lumbosacral radiculopathy. But controversies are prevalent regarding the effectiveness of their treatmentin previous studies. N-SNAG is also a comparatively new technique that is clinically being used around, but more literature is neededto analyze its effectiveness. Hence, we aimed to evaluate the efficacy of N-SNAG in comparison with NM and conventional generalexercises in treating lumbosacral radiculopathy on pain, mobility, disability, muscle activation, and health-related quality of life(HRQL). One hundred and twenty-seven patients aged between 30 and 50 years were randomly allocated into 3 different treatmentgroups, where the first and second groups received N-SNAG and NM with general exercises, and the third (control) group receivedgeneral exercises only. Range of motion of lumbar and hip flexion, active straight leg raising, low back pain, radiculopathy pain, muscleactivation of biceps femoris and gastrocnemius muscles, disability, and HRQL were evaluated at baseline, and the end of 1st week, 2ndweek, 7th week and 18th week for all the groups. Two-way repeated measure ANOVA with Bonferroni’s t-test revealed significant(p&lt;0.05) improvement in the range of lumbar and hip flexion, LBP, radiculopathy pain, active SLR, disability, and HRQL in both withingroups and between groups. Muscle activation of biceps femoris and gastrocnemius also improved significantly (p&lt;0.05) in all threegroups, but no significant (p&gt;0.05) differences were seen between groups. The study concludes that N-SNAG is more efficient thanNM and general exercise in improving pain, lumbar and hip flexion range, SLR, disability, Muscle activation, and HRQL in Lumbosacralradiculopathy patients.

Compare the Effectiveness of Mulligan (Nags &amp; Snags) and McKenzie (Self-Stretching) On Improving the Pain and Functional Ability in Patient with Chronic Neck Pain

Neck pain is Consider the major problems and the prevalence of this musculoskeletal disorders are very common in people. Objective: To compare the effectiveness of mulligan and McKenzie on improving pain and functional ability in chronic neck patient. Methods: This trial was registered with Iranian trail registry with reference no: IRCT20220414054537N4. It’s a Double-Blind Randomized Clinical Trial that was conducted in DHQ Hospital Shadrah a affiliated teaching hospital attached with Afro-Asia University Lahore from 1 May 2022 to 30 June 2022.The sample size was calculated and total 26 patients were divided into two groups. The ages of the patients were around 20-55 years old. The entire patient having the mechanical neck pain was included in this study. Patients were selected from DHQ hospital in May to June 2022 duration. In group A we applied the mulligan technique of manual therapy treatment that included the Natural apophyseal glides, sustained natural apophyseal glides and Self SNAGs in sitting position of the patient. The second group of 13 patients had applied the Mackenzie exercises in seven motions like 4 movement of neck extension,2 movements in lateral flexion and rotation and one movement in flexion direction. Results: Overall the post Numeric pain rating scale and Neck Disability index was significantly improved in group A which received the NAGs &amp; SNAGs Mobilization technique. Conclusion: Mulligan (NAGs SNAGS) is effective than Mackenzie (self-stretching) treatment technique to improve the functional ability and reducing pain in chronic neck patient.

COMBINATION OF ULTRASOUND THERAPY, MUSCLE ENERGY TECHNIQUE, AND SUSTAINED NATURAL APOPHYSEAL GLIDES IN NON-SPECIFIC NECK PAIN – A CASE SERIES

Background: Non-specific neck pain is a common neuromusculoskeletal problem and affects about two thirds of people worldwide. Purpose: To find out the efficacy of the combination therapy in individuals with non-specific neck pain. Case: The intervention was given in 12 sessions (3 times per week for 4 weeks) with the total duration of therapy per session is 20 minutes. The sequence of interventions includes: ultrasound therapy, application of muscle energy techniques, and SNAGs mobilization. Evaluation of therapy in the form of pain was measured by a visual analogue scale and the range of motion of the cervical spine’s lateral flexion was measured by a goniometer. Result: The results of the case series showed a decrease in pain scores from an average of 5.67 to 2.73. In the range of motion of the cervical spine’s lateral flexion there was an increase from an average of 30 degrees to 36 degrees. Conclusion: The combination of ultrasound therapy, muscle energy technique, and sustained natural apophyseal glides provided benefits in reducing pain and increasing the range of motion of the cervical spine’s lateral flexion in individuals with non-specific neck pain. This case series can be used as a preliminary study to develop further research with experimental methods in proving the effectiveness of the combination therapy in treating non-specific neck pain.

Mid-term Effect of Lumbar Sustained Natural Apophyseal Glides in Patients with Non-specific Chronic Low Back Pain: A Randomized Clinical Trial.

The objective of this study was to compare the standalone and combined mid-term effects of conventional physiotherapy and lumbar sustained natural apophyseal glides on pain, range of motion, fear avoidance belief, and functional status in patients with non-specific chronic low back pain. This randomized clinical study was conducted in a state hospital. Fifty-five patients with non-specific chronic low back pain (mean age: 40.69 ± 6.27 years) were divided into 3 groups. Group I (n=18) received conventional physiotherapy (electrotherapy and heat application) 5 days a week for 3 weeks, group II (n=19) received lumbar sustained natural apophyseal glides 3 days a week for 3 weeks. Group III (n = 18) received conventional physiotherapy plus lumbar sustained natural apophyseal glides. Pain (visual analog scale), flexion range of motion (back range of motion II), functional status (Roland-Morris Disability Questionnaire), and fear avoidance belief (Fear Avoidance Belief Questionnaire) were assessed at baseline, third week, and 6-month follow-up. After 3 weeks of intervention, all outcome measures improved in groups II and III. These improve- ments remained significant until 6-month follow-up (P < .05), except fear avoidance belief (P=.06) and flexion range of motion (P=.764) scores of group III. Flexion range of motion (P=.001), functional status (P = .001), and fear avoidance belief (P = .03) differed significantly between the 3 groups at 6-month follow- up; post-hoc analysis revealed that flexion range of motion (P < .0001), functional status (P = .037), and fear avoidance belief (P = .002) scores were significantly improved in group II compared to group I. Compared with conventional physiotherapy, lumbar sustained natural apophyseal glides improved mid-term range of motion, functional status, and fear avoidance belief, but there was no differ- ence in pain. Conventional physiotherapy added to lumbar sustained natural apophyseal glides provided no additional benefit.

Manual Therapy versus Localisation (Tactile, Sensory Training) in Patients with Non-Specific Neck Pain: A Randomised Clinical Pilot Trial.

Manual therapy (MT) techniques typically incorporate localised touch on the skin with the application of specific kinetic forces. The contribution of localised touch to the effectiveness of MT techniques has not been evaluated. This study investigated the immediate effects of MT versus localisation training (LT) on pain intensity and range of movement (ROM) for neck pain. In this single-blind randomised controlled trial thirty eligible neck pain volunteers (23 females and 7 males), aged 28.63 ± 12.49 years, were randomly allocated to MT or to a motionless (LT) group. A single three-minute treatment session was delivered to each group's cervico-thoracic area. The LT involved tactile sensory stimulation applied randomly to one out of a nine-block grid. Subjects were asked to identify the number of the square being touched, reflecting a different location on the region of skin. MT involved three-minute anteroposterior (AP) glides and sustained natural apophyseal glides (SNAG) techniques. Pre- and post-intervention pain intensity were assessed using a pressure pain threshold (PPT) algometer and the numeric pain rating scale (NPRS). Neck ROM was recorded with a bubble inclinometer. Improvements in ROM and self-reported pain were recorded in both groups (p < 0.001) without differences in NPRS, ROM or PPT scores between groups (p > 0.05). Tactile sensory training (localisation) was as effective as MT in reducing neck pain, suggesting a component of MT's analgesic effect to be related with the element of localised touch rather than the forces induced during passive movements.

Efficacy of a Mulligan Concept Sustained Natural Apophyseal Glide Technique for Cervicogenic Headache: A Critically Appraised Topic

Clinical Question: In adults with cervicogenic headache (CGH), what are the effects of a clinician-applied Mulligan Concept C1–C2 rotational sustained natural apophyseal glide on cervicogenic symptomology? Clinical Bottom Line: Both Level 2b and Level 4 evidence of Grade B quality exists to support using the C1–C2 rotational sustained natural apophyseal glide to decrease CGH severity and participant-reported neck disability immediately posttreatment, while also increasing cervical range of motion in adult patients with CGH headaches and a positive flexion–rotation test. Further research should examine the long-term effects of the C1–C2 rotational sustained natural apophyseal glide technique on cervical range of motion, flexion–rotation test results, and CGH frequency and severity. In addition, the flexion–rotation test should be explored as a standard diagnostic assessment in CGH cases.

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

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

Effects of sustained natural apophyseal glides combined with transcutaneous electrical nerve stimulation in cervical radiculopathy

To analyze the effects of Sustained Natural Apophyseal Glides (SNAGs) combined with Transcutaneous Electrical Nerve Stimulation (TENS) in Cervical Radiculopathy. Quasi experimental study design was selected. Samples of 20 male and female participants diagnosed with cervical radiculopathy were assigned to receive SNAGs combined with TENS. Age of population between 35 to 55 years. The duration of intervention was 4 weeks, at 4 sessions per week. The Visual Analogue Scale (VAS) for pain and Goniometer for cervical range of motion (ROM) were assessment tools used for all the participants before and after 4 weeks of physical therapy intervention. All the participants were assessed through VAS and Goniometer before intervention and at the completion of 4 weeks program. P-value of mean was used to analyze the data. From the findings it is concluded that SNAGs combined with TENS was more effective in the treatment of cervical radiculopathy.

Comparison between Mulligan Sustained natural apophyseal glides (snags) VS McKenzie exercises in Chronic Mechanical Low back pain

Background: Low back pain is a common musculoskeletal problem of the modern society as 70-80% people of any age and gender get affected by this in their lifetime which affect their normal activities of daily living. Aim: To compare the efficacy between Mulligan SNAGs and McKenzie exercises in improving pain level, range of motions and functional status in chronic mechanic al low back pain patients. Method: A randomized control trial study was conducted on 45 patients suffering from chronic mechanical low back pain at Physiotherapy Department of Mayo Hospital Lahore from16th December to 21th January 2021.The patients were randomly allocated in three group’s i.e; Conventional and two trial groups by computerized generated list. In Conventional group; 15 patients were treated with conventional therapy. In trial groups; one was treated with Mulligan SNAGs and Conventional therapyand the other trial group were treated with McKenzie exercises and Conventional therapy 3 sessions per week. Pain measured by Numeric Pain Rating Scale (NPRS), Lumbar spine's ranges measured by Goniometer and functional status measured by Oswestry Disability Index (ODI) at the completion of the 4 weeks treatment session. Results: NPRS scoring and Ranges showed significant improvement in all groups but NPRS significantly improved in McKenzie exercises group and significant improvement in ROM showed in Mulligan SNAGs group in all movements but there was no significant difference found between three groups comparison in improving the functional status with p-value =0.243. Practical implication: The study provides the opportunity to the patients to consider physiotherapy as an effective treatment for the mechanical low back pain. It also provides the statistical knowledge about these physiotherapy techniques and their effectiveness in treating the low back pain. Conclusion: Both the Mulligan SNAGs and McKenzie exercises are effective in treatment of Chronic lumbar pain as pain is most reduced through McKenzie exercise (3.33±1.29, p&lt;0.000) while ranges of spine is improved through Mulligan SNAGs mobilization in all directions. Keywords: Chronic Mechanical Low back pain, Mulligan SNAGs mobilization, McKenzie exercises

Comparison of Sustained Natural Apophyseal Glide and Natural Apophyseal Glide Effects on Pain, Range of Motion and Neck Disability in Patients with Chronic Neck Pain

Neck pain is very common in this era, and people have been suffering for many years. As the more advanced techniques of Mulligan, Sustained Natural Apophyseal Glide and Natural Apophyseal Glide are used to relieve pain, increase range of motion, and reduce neck disability in patients with chronic neck pain. Objectives: To compare the efficacy of sustained natural apophyseal glides and natural apophyseal glides in patients of with chronic neck pain. Methods: In this study, randomized clinical trial was done, a total of 45 subjects met the inclusion criteria out of which 5 were dropped out. 40 participants were included, both male and females diagnosed with chronic neck pain between the age of 25-50 years, and 20, 20 patients were randomly allocated into group A and B. Outcome measure tools were visual analog scale and Neck Disability Index (NDI) to assess. Group A received sustained natural apophyseal glides, Group B received natural apophyseal glides three times per week for 2 weeks. Results: In this study, the intragroup analysis revealed that relief of pain, improvement in range of motion, and reduction in disability were statistically significant in groups A and B (p&lt;0.5). While Group A was statistically significant as compared to Group B. Conclusions: This study concluded that both the groups are effective, but the Sustained Natural Apophyseal Glides technique was more effective in pain relief, improvement of cervical range of motion, and reduction of neck disability in patients with chronic neck pain

Effects of cervical traction mobilization with mulligan’s SNAGS on Pain, cardiovascular and respiratory outcomes among young adults with cervical pain.

Objective: To determine the effect of Mulligan’s Cervical Sustained natural Apophyseal glide and cervical traction cardiovascular and respiratory outcomes; systolic blood pressure, diastolic blood pressure, heart rate, ventilation rate, oxygen saturation, neck disability index and cervical range of motion. Study Design: Randomized Control Trial. Setting: Shifa Tameer-e-Millat University, Islamabad Pakistan. Period: November 2021 to March 2022. Material &amp; Methods: A total of 84 participants with age range of 18 to 24 years of either gender with cervical pain and hypo mobility were included in the study whereas individuals with history of cervical trauma or injury, any structural deformity, vertebral instability, cardiac and respiratory complications were excluded. These participants were randomly allocated into two groups by using toss and trial method. Experimental group received sustained natural apophyseal glide and traction while the control group was subjected to traction alone. A total of four sessions were provided over a course of four weeks, with two weeks interval between them. Pre and post vitals including blood pressure, heart rate, respiratory rate and oxygen saturation were monitored at each session along with Numeric Pain Rating scale, Neck disability index and cervical range of motion. Results: Mean age of the participants was 21.70±2 years. Both groups showed significant reduction in pain with p value&lt; 0.05 whereas heart rate was significantly increased in experimental group with pre median 81.75(16.6) and post median 82.00(15.05). Flexion range of motion was significantly improved in experimental group with pre median 69.00(15) and post median 71.00(11.7). Cervical left side bending was significantly improved with p value 0.04. Other variables including ventilation rate, oxygen saturation, systolic and diastolic blood pressure, Neck Disability Index, and other cervical range of motion showed no statistically significant difference with p value &gt;0.05. Conclusion: The study results show improvement in both groups in terms of cardiovascular and respiratory outcomes but experimental group has more significant reduction in pain and change in pulse rate.

Effectiveness of sustained natural apophyseal glides in females with cervicogenic headache: A randomized controlled trial.

Cervicogenic headache (CGH) is a common condition that results in significant disability. To treat this dysfunction, Mulligan described sustained natural apophyseal glides (SNAGs) as a manual therapy approach. However, only inconclusive short-term evidence exists for treating CGH with SNAGs. The present study aims to investigate the effect of SNAGs in the treatment of CGH. Fourty female patients ranging from 20 to 40 years with CGH were randomly assigned to two groups: 20 in a treatment group and 20 in a control group. SNAGs were applied to the treatment group while the control group received placebo treatment. Both groups received their respective treatment for 20 minutes, alternately three times per week, for a total of 12 times in four weeks. The outcome measures were the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). Participants were assessed at baseline and at the end of each week. The data was analyzed using SPSS version 20. Independent t-testing was used to reveal changes between groups. One-way ANOVA was used to determine changes within groups. The level of significance was P< 0.05. Twenty participants (100%) in the treatment group and 17 (85%) in the control group had a history of headache aggravation with active movements or passive head positioning. There was no significant difference at baseline (p> 0.05), indicating that both groups were homogeneous at the time of recruitment. The p value (p< 0.05) showed a significant difference in pain and level of disability at three and four weeks (p< 0.05) in patients treated with SNAGs. However, the cervical range of motion (ROM) showed a statistically significant improvement in flexion and extension in the treatment group (p< 0.05) while there was no significant improvement in side flexion and rotation ROM in both groups (p> 0.05). This study found that SNAGs were effective in reducing pain and neck disability and improved ROM in females with CGH.

Combination Intervention Mulligan’s Sustained Natural Apophyseal Glides and Ultrasounds Better Than Combination Intervention Stretching And Ultrasounds For Increasing Functional Activity Non-Specific Low Back Pain Patient

Abstract— Non-specific low back pain is one of the complaints that very often encountered with a picture of complaints originating without a clear cause. Non-specific low back pain is often a reason for the limitation of functional activity in patients because of pain symptoms and muscle tightness around the patient's lower back. The aim of this research is to prove that the Mulligan intervention, namely SNAGS as the latest intervention combined with physiotherapy modalities of ultrasounds, is more effective in improving the functional quality of non-specific low back pain patients than the combination of conventional stretching interventions with ultrasounds. The research method used in this study is the design of experimental research methods in the form of a pre-test and post-test two group design. In its implementation, there will be two groups with the number of each sample in each group consisting of 16 samples selected at random with the block permutation technique. Group 1 will receive conventional stretching and ultrasounds, while group 2 will receive mulligan's “sustained natural apophyseal glides” (SNAGS) and ultrasounds. The patient's functional activity was measured by the MODI (Modified Oswestry Disability Index) questionnaire. The study was conducted at a physiotherapy clinic in Denpasar. The results obtained in this study after processing the Paired T-Test test data in each group to determine whether there is a significant difference between pre and post from each combination, obtained with a p value &lt;0.05, this indicates that there is a difference significant. The difference test between groups was carried out showing that there was a significant difference between the treatment group and the control group with the Independent T-Test test, getting a p value of &lt;0.05 which has an interpretation of a significant difference. The conclusion obtained after the test and discussion of this study is that the mulligan intervention, namely SNAGS as the latest intervention combined with physiotherapy modalities of ultrasounds, is more effective in improving the functional quality of patients with non-specific low back pain than the combination of conventional stretching interventions with ultrasounds.&#x0D; &#x0D; Keywords: Mulligan's SNAGS, Ultrasound, Conventional Stretching, Non Specific Low Back Pain, Decreased Functional Activity

Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review.

The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness. MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated. A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study-specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used. Of a total of 14 articles selected, 11 were randomized control trials and three were quasi-experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan's Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short-term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long-term results. The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi-experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.

Short-term Effect of Mulligan SNAGs on Pain Intensity, Cervical Range of Motion and Craniovertebral Angle in Patients with Non Specific Neck Pain: A Quasi-experimental Study

Introduction: The extended use of smartphone, laptops and computers alters the posture of the neck which results in non specific neck pain. Though the physical therapy modalities give symptomatic relief, the forward head posture is left uncorrected. Mulligan Sustained Natural Apophyseal Glides (SNAGs) stimulate the mechanoreceptors and proprioceptors around the joints that might correct the faulty posture of neck. Aim: To evaluate the short-term effect of mulligan SNAGs on pain intensity, cervical range of motion and craniovertebral angle in patients with non specific neck pain. Materials and Methods: This quasi-experimental study was conducted in Department of Physical Medicine and Rehabilitation at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India, from August 2021 to October 2021. Total 20 patients diagnosed having non specific neck pain and Craniovertebral angle (CV) angle less than 45 degrees were included in the study. The participants were randomly allotted into two groups. Group A received interferential therapy and static neck exercises. Whereas, group B received Mulligan SNAGs in addition to interferential therapy and static neck exercises and serves as the experimental group. Mulligan SNAGs was given to each cervical movement as six repetitions× two sets/ session ×three sessions/week. The intervention was given for 2 weeks. preintervention and postintervention evaluation of pain intensity, cervical range of motion and CV angle was made and statistically analysed using Paired t-test for within group analysis and independent t-test for between group analysis at 5% level of significance (p-value &lt;0.05). Results: The mean age the participants in group A was (32.2±6.3 years) and group B was (32.7±6.03). Within group analysis was made and it was observed that group A and B showed significant reduction in Numerical Pain Rating Scale (NPRS) score (p-value=0.004, p-value=0.005), improvement in CV angle (p-value=0.001, p-value=0.001) and increased cervical range of flexion (p-value=0.001, p-value=0.001), cervical extension (p-value=0.004, p-value=0.001) and rotation movements (p-value &lt;0.05), respectively. The between group analysis of pre-post mean differences in the NPRS score (3.30±0.67, 4.60±0.96), CV angle (0.46±0.24, 5.62±1.21), cervical movement of flexion (10±2.36, 19±4.59), extension (6.50±2.53, 21±8.23), right lateral rotation (8±2.58, 15±4.08) and left lateral rotation (8.5±2.49, 16±4.24) was made using Independent samples t-test. It was observed that, all the outcomes showed significant difference. The mean difference in the outcome measures were significantly greater in group B who received mulligan SNAGs than group A. Conclusion: Thus, the short-term application of Mulligan SNAGs along with conventional physiotherapy proves good in reducing pain, improving cervical range of motion and normalizing the reduced CV angle in patients with non specific neck pain.

EFFECTS OF LUMBAR SNAG AND MECHANICAL TRACTION IN PATIENTS WITH DISCOGENIC LUMBOSACRAL RADICULOPATHY

Objective: To compare the effects of lumbar sustained natural apophyseal glide and Mechanical Traction in patients with discogenic lumbosacral radiculopathy.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Kanaan Physiotherapy and Spine Clinic, from Mar to Sep 2020.&#x0D; Methodology: A total of 44 patients were included in study in 2 groups of 22 each. Patients between ages 30-60 years having chronic radiating pain in one or both legs, patients with minimum of 25 score out of 100, on low back pain index and patients having radiculopathy were included. Exclusion criteria were history of low back pain treatment in last 90. Complications such as cancer, spine pathology and joint disease. Dice roll method was used for group allocation. Group classification was as group 1, sustained natural apophyseal glide group, and group 2, mechanical traction group. NPRS and oswestry disability index were used. Data analysis was done with SPSS version 21.&#x0D; Results: There is statistically significant improvement in pain as mean post treatment value for sustained natural apophyseal glide group is 2.55 ± 1.503 and for mechanical traction group is 4.05 ± 1.864, oswestry disability index and shober test results in sustained natural apophyseal glide group were also significant as compared to mechanical traction with p-value &lt;0.05. Although pain was also decreased in mechanical traction group patients but overall sustained natural apophyseal glides were more effective.&#x0D; Conclusion: Sustained natural apophyseal glide are more effective in the treatment of lumber radiculopathy patients as compared to mechanical traction. Further studies.............