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

Riphah International University

Status: Not yet enrolling

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

Treatments: Other: Cervical Stabilization Exercises; Other: Cognitive behavior therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT06996015

REC/RCR&AHS/24/0154

Details and patient eligibility

About

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.

Full 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.

Enrollment: 32 estimated patients

Sex: All

Ages: 18 to 28 years old

Volunteers: No Healthy Volunteers

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)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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32 participants in 2 patient groups

Cognitive Behavior Therapy

Experimental group

Description:

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.

Treatment:

Other: Cognitive behavior therapy

Cervical Stabilization Exercises

Active Comparator group

Description:

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.

Treatment:

Other: Cervical Stabilization Exercises