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

Not Applicable

Recruiting

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

• Registration Number: NCT06996015
• Lead Sponsor: Riphah International University

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.

Study Timeline

• Study First Submitted: 2025-03-10
• Study First Submitted QC: 2025-05-21
• Study First Posted: 2025-05-30
• Study Start: 2025-06-10
• Status Verified: 2025-07
• Last Update Submitted: 2025-07-03
• Last Update Posted: 2025-07-04
• Primary Completion: 2025-10-01
• Study Completion: 2025-12-10

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 32

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)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
NPRS	4th week	Numerical Pain Rating Scale (NPRS) To determine the degree of pain that the patient will report, the Numeric Pain Rating Scale (NPRS) will be utilized. This scale consists of 11 points ranging from 0-10, where zero indicates no pain, five represents moderate pain intensity, and ten signifies severe pain intensity.; An intraclass correlation value (ICC) of 0.67 indicated a moderate level of reliability for the NPRS (Numeric Pain Rating Scale), indicating a moderate level of consistency and stability in the scores obtained from the measurement tool.(24) NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively) (19).; The measurements for pain intensity will be recorded through this scale at baseline, and after 4 weeks of treatment
Neck Disability Index	4th week	To assess neck-related disability, a questionnaire called the Neck Disability Index (NDI) will be used. It consists of eleven things that address pain and regular tasks such personal care, lifting, reading, headaches, focusing, work status, driving, sleeping, and recreation.; The intraclass correlation coefficient (ICC) for the NDI (Neck Disability Index) is 0.88, indicating very high reliability, indicating a high level of consistency and stability of scores obtained from the measurement tool.(24) It has been demonstrated that the NDI-U questionnaire can accurately assess neck impairment in Urdu-speaking individuals with chronic musculoskeletal neck pain (CMNP). Its two-factor structure and use of simple language make it easy for patients to understand, making it a suitable assessment tool in both clinical and research settings for patients population.(25)

Secondary Outcome Measures

Name	Time	Method
Craniovertebral Angle	4th week	Photogrammetric method (for Measuring Craniovertebral Angle): Neck pain is frequently brought on by the forward head posture, also referred to as the Craniovertebral Angle (CA). It is calculated using the angle created by a horizontal line going through the spinous process of C7 and a line originating from the tragus of the ear.; According to intraclass correlation coefficient (ICC) values ranging from 0.88 to 0.98, photogrammetry in the sagittal plane is a trustworthy technique for determining forward head posture. This method has been utilized in several research studies to measure forward head posture.; When used to evaluate cervical range of motion in the sagittal plane, the Kinovea software has also been demonstrated to have both intrarater and interrater reliability.; This angle will be used to assess the degree of forward head posture in patients.

Trial Locations

Locations (1)

Syeda Khatoon e Jannat Trust Hospital,; 🇵🇰 Faisalabad, Punjab, Pakistan