Effects of SNAGs & CBT on Pain, Craniovertebral Angle & Disability in Non Specific Neck Pain

NCT ID: NCT06996015

Last Updated: 2025-07-04

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-06-10
• Study Completion Date: 2025-12-10

Brief Summary

Non-specific neck pain is a prevalent condition causing discomfort, reduced craniovertebral angle, and disability. This randomized controlled trial will evaluate the combined effects of Sustained Natural Apophyseal Glides (SNAGs) and Cognitive Behavioral Therapy (CBT) on pain, posture, and function. Group A will receive SNAGs and CBT, while Group B will undergo SNAGs with cervical stabilization exercises, twice weekly for four weeks. Outcomes will include pain, craniovertebral angle, and disability, analyzed using SPSS.

Detailed Description

Non-specific neck pain is a common musculoskeletal disorder that will affect a significant portion of the population, leading to discomfort, reduced craniovertebral angle, and functional disability. While traditional physical therapy methods provide symptomatic relief, there is growing interest in integrating psychological interventions to address underlying factors contributing to chronic pain. This study will investigate the combined effects of Sustained Natural Apophyseal Glides (SNAGs) and Cognitive Behavioral Therapy (CBT) on pain reduction, craniovertebral angle improvement, and disability in patients with non-specific neck pain.

This study will be a randomized controlled trial involving -- patients diagnosed with non-specific neck pain. Participants will be randomly assigned into two groups. Both groups will receive conservative treatment, including a 5-minute hot pack application and 5 minutes of myofascial release. Subsequently, SNAGs will be administered for 10 minutes to both groups. Group A will receive an additional 20-minute session of Cognitive Behavioral Therapy (CBT) focusing on pain management strategies. In contrast, Group B will receive cervical stabilization exercises for 20 minutes. The intervention will be administered twice a week for four weeks. Pain intensity, craniovertebral angle, and disability will be measured at baseline and post-intervention using standardized assessment tools. Data analysis will be performed using SPSS version 25, with within-group and between-group comparisons to evaluate the efficacy of the interventions.

Existing studies focus on manual therapies and short-term outcomes but lack insights into the combined and sustained effects of SNAGs and CBT. This research aims to bridge that gap, exploring the physical and psychological dimensions of treatment to improve long-term function and patient well-being.

Conditions

Neck Pain; Cognitive Behavior Therapy; Cervicalgia; Posture; Posterior Neck Pain; Neck Pain and Forward Head Posture

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Cognitive Behavior Therapy

Cognitive Behavioral Therapy will be delivered in 20-minute sessions using visual aids like videos, images, and pamphlets to explain cervical spine structure, biomechanics, pain pathways, and ergonomic practices. Techniques for managing flare-ups and maintaining good posture will be taught, ensuring active engagement and focus. A manual summarizing key points will be provided, and students will be encouraged to ask questions. Sessions will occur twice weekly for four weeks.

Group Type: EXPERIMENTAL

Cognitive behavior therapy

Intervention Type: OTHER

The treatment session will begin with a 10-minute conventional therapy, including a 5-minute hot pack applied to the cervical region and a 5-minute Myofascial Release (MFR) using skin rolling and cross-hand techniques to relax and stretch the fascia layers. This will be followed by a 10-minute application of Sustained Natural Apophyseal Glides (SNAGs), where the physiotherapist will guide the patient's active neck movements with accessory glides to improve joint ROM and reduce pain. Lastly, a 20-minute Cognitive Behavioral Therapy (CBT) session will include visual aids, explanations of cervical spine biomechanics, pain pathways, ergonomics, and posture management. Patients will receive manuals summarizing key points and be encouraged to engage actively. The 40-minute session will be conducted twice weekly for four weeks

Cervical Stabilization Exercises

Cervical Stabilization Exercises (CSE) will include bracing techniques in neurodevelopmental stages (supine, prone, quadrupedal, bipedal) with 10-second holds for 10 repetitions. Extremity ROM exercises will be done while maintaining spinal stability, progressing from 8 to 12 reps. Cervical isometric exercises will target multiple directions using elastic bands, with 10 reps and 6-10 second holds. Functional training with elastic resistance and exercise balls on unstable surfaces will also be incorporated, with 10 reps and 10-15 second holds. Sessions will occur twice weekly for four weeks.

Group Type: ACTIVE_COMPARATOR

Cervical Stabilization Exercises

Intervention Type: OTHER

The treatment session will last 40 minutes, twice a week for 4 weeks. It begins with a 10-minute conventional treatment: a 5-minute hot pack application to the cervical region followed by a 5-minute Myofascial Release (MFR) using the skin rolling technique. Natural wax will be applied for smooth strokes. MFR will engage all fascia layers with superficial strokes, progressing to deeper fascia using cross-hand stretch, depending on the pain tolerance.

Next, SNAGs (Sustained Natural Apophyseal Glides) will be applied for 10 minutes. The patient, seated, will actively move the painful joint through its range of motion while the therapist applies a glide force. This will be repeated 10 times for 3 sets.

Then session includes 20 minutes of Cervical Stabilization Exercises (CSE) with bracing in neurodevelopment stages (supine, prone, quadrupedal, bipedal), holding each position for 10 seconds. Isometric exercises and functional training with elastic bands and exercise balls follow.

Interventions

Cognitive behavior therapy

The treatment session will begin with a 10-minute conventional therapy, including a 5-minute hot pack applied to the cervical region and a 5-minute Myofascial Release (MFR) using skin rolling and cross-hand techniques to relax and stretch the fascia layers. This will be followed by a 10-minute application of Sustained Natural Apophyseal Glides (SNAGs), where the physiotherapist will guide the patient's active neck movements with accessory glides to improve joint ROM and reduce pain. Lastly, a 20-minute Cognitive Behavioral Therapy (CBT) session will include visual aids, explanations of cervical spine biomechanics, pain pathways, ergonomics, and posture management. Patients will receive manuals summarizing key points and be encouraged to engage actively. The 40-minute session will be conducted twice weekly for four weeks

Intervention Type: OTHER

Cervical Stabilization Exercises

The treatment session will last 40 minutes, twice a week for 4 weeks. It begins with a 10-minute conventional treatment: a 5-minute hot pack application to the cervical region followed by a 5-minute Myofascial Release (MFR) using the skin rolling technique. Natural wax will be applied for smooth strokes. MFR will engage all fascia layers with superficial strokes, progressing to deeper fascia using cross-hand stretch, depending on the pain tolerance.

Next, SNAGs (Sustained Natural Apophyseal Glides) will be applied for 10 minutes. The patient, seated, will actively move the painful joint through its range of motion while the therapist applies a glide force. This will be repeated 10 times for 3 sets.

Then session includes 20 minutes of Cervical Stabilization Exercises (CSE) with bracing in neurodevelopment stages (supine, prone, quadrupedal, bipedal), holding each position for 10 seconds. Isometric exercises and functional training with elastic bands and exercise balls follow.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age group: 18-28 Years(20)
• Gender Group: Both male and female participants(20)
• Individuals with a Craniovertebral angle <53(20)
• Individuals having grade 2 neck pain according to KNGF Guidelines.(21)
• Individuals having localized pain or stiffness in spine or both combined between C3 and C7 without upper-limb radiculopathy(22)
• Individual who had not received any treatment for neck pain for the last 3 months will be included in the study.
• Patients willing to sign written consent form.

Exclusion Criteria

• Those who had undergone spinal surgery(23)
• Neck pain caused by various pathologies (rheumatoid arthritis, ankylosing spondylitis, fracture, tumor, etc.)(23)
• Nerve root compression, (23)
• A positive vertebrobasilar artery test, (23)
• Severe radiculopathy,(23)
• Osteoporosis, or osteopenia(23)
• Long-term use of corticosteroids or anticoagulants (23)

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 28 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Hira Shaukat, TDPT

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Syeda Khatoon e Jannat Trust Hospital,

Faisalabad, Punjab Province, Pakistan

Site Status: RECRUITING

Countries

Pakistan

Central Contacts

Imran Amjad, pHD

Role: CONTACT

imran.amjad@riphah.edu.pk

03324390125

Facility Contacts

Hira Shaukat, TDPT

Role: primary

hira.shaukat@riphah.edu.pk

03360405480

Other Identifiers

REC/RCR&AHS/24/0154

Identifier Type: -

Identifier Source: org_study_id