Effectiveness of Mulligan SNAG Mobilisation on Muscle Activation, Pain, Disability and Sleep Quality in Acute Neck Pain: A Randomised Controlled Trial

Introduction: Neck pain is a disabling problem faced frequently by people across the globe and acute neck pain is more prevalent among the adult age group due to posture abnormalities and dysfunctions. It is necessary to establish the treatment strategies that can help reduce the overall disability and functional impairments and impact the sleep quality. Aim: To determine the effect of Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisations on Electromyographic (EMG) activity of neck muscles (upper trapezius and splenius capitis), sleep quality, neck disability, pain and pain pressure threshold in subjects with acute neck pain and compare it with conventional rehabilitation. Materials and Methods: A single-blinded randomised control trial was carried out with a sample of 32 subjects, recruited from the Department of Centre for Physiotherapy and Rehabilitation, Jamia Millia Islamia, New Delhi, India from October, 2018 to March, 2019. The study included adults (male and female) aged 18-40 years with acute neck pain lasting ≥4 weeks, Numeric Pain Rating Scale (NPRS) score ≥6, and symptoms reproduced by neck motion. Participants were divided into two groups (n=16 in each group). Subjects in Group-1 were given intervention for neck pain in the form of Mulligan SNAG mobilisation along with cervical stabilisation exercises three times per week for four weeks. Subjects in Group-2 received only cervical stabilisation exercises three times per week for four weeks. For investigating the effect of the two interventions on EMG activity of neck muscles, sleep quality, neck disability, pain and pain pressure threshold, repeated measures Analysis of Variance (ANOVA) was applied for parametric variables and Wilcoxon Signed-rank Test was used to establish the within group difference of non parametric variables. Level of significance was set at p<0.05. Results: The result indicated that both the treatments improved the parameters. Group×Time interaction was found to be significant (p>0.05) in splenius muscle activity and group effect was significant (p>0.05) in pain pressure threshold, However, significant time effect was seen in all the variable (p>0.05). Conclusion: The present study concludes that Mulligan SNAG mobilisation can be used as an adjunct to conventional exercise programmes to improve subjective sleep quality parameters, neck extensor muscle activity, neck disability, pain and pain pressure threshold in patients with acute neck pain.