Effectiveness of apophyseal glides with and without thoracic postural correction in mechanical neck pain; a randomized controlled trial

Mechanical neck pain (MNP) is the predominant kind of pain in neck encountered, characterized by nonspecific discomfort in the neck area without any specific anatomical cause which can result in pain, muscle spasms, limited mobility, and functional impairment. Mobilization with movement (MWM) is a treatment approach utilized for managing neck pain. By combining joint mobilization with Thoracic Postural Correction Techniques (TPCT), the MWM approach aims to improve overall function, reduce pain intensity, and enhance cervical Range of Motion (ROM) in individuals with neck pain. This randomized controlled trial recruited twenty-eight patients from physiotherapy department of International Therapy Services Clinic, Lahore according to selection criteria. After taking written consent, patients were allocated into control group as well as the experimental group by computer generated random number method. Control group was treated with Sustained Natural Apophyseal Glides (SNAGs) and experimental group was treated with SNAGS as well as TPCT. Pain was assessed using the Numeric Pain Rating Scale (NPRS), disability with the Neck Disability Index Urdu (NDI-U), and cervical range of motion (ROM) using a universal goniometer, all measured by the same assessor at baseline, 3 weeks, and 6 weeks. SPSS 25, a statistical tool for social sciences, was used for the analysis. A comparison between groups was conducted using an independent t-test, while a repeated measures ANOVA was employed to assess variations within the groups. In the experimental group, significant improvements were observed across various measures at the 6th week assessment. The NPRS showed a mean difference of 0.71 and an effect size of 0.88, while the NDI-U demonstrated a mean difference of 2.71 and an effect size of 0.80. Regarding cervical ROM, cervical flexion displayed a mean difference of 4.42 with an effect size of 1.70, and cervical extension had a mean difference of 4.15 with an effect size of 1.49. Notably, cervical right side bending showed a mean difference of 4.92 with an effect size of 2.43, and cervical left side bending had a mean difference of 3.3 with an effect size of 2.27. Moreover, cervical right rotation exhibited a mean difference of 3.86 with an effect size of 1.95, while cervical left rotation showed a mean difference of 4.57 with an effect size of 1.28. Overall, these findings indicate significant improvements in pain, disability, and cervical ROM by the 6th week of treatment. The findings of this study indicate that the addition of thoracic postural correction exercises to sustained natural apophyseal glides resulted in both statistically significant and clinically meaningful improvements across all outcome measures. This combined intervention was more effective than sustained natural apophyseal glides alone in enhancing cervical range of motion, reducing disability, and relieving pain in individuals with mechanical neck pain. These results indicate that adding TPCT to treatment strategies for MNP may enhance patient outcomes by improving function and reducing pain. This trial has been registered in Iranian Registry of Clinical Trial at 06/03/2023 with reference number IRCT20190717044238N5.