Proprioceptive Neuromuscular Facilitation And Passive Vertebral Mobilization For Neck Disability In Patients With Mechanical Neck Pain

University of Lahore

Status: Completed

Conditions: Proprioceptive Neuromuscular Facilitation; Mechanical Neck Pain; Neck Pain Musculoskeletal; Neck Pain; Mobilization

Treatments: Other: Passive Vertebral Mobilization (PVM); Other: Proprioceptive Neuromuscular Facilitation (PNF)

Study type: Interventional

Funder types: Other

Identifiers

NCT07042230

Rec-UOL-/506/08/24

Details and patient eligibility

About

Mechanical neck pain is a common musculoskeletal condition that affects many people, especially those with poor posture or repetitive neck movements. It can cause discomfort, reduce the ability to move the neck, and affect daily functioning. This study aimed to compare the effects of two physiotherapy treatments-Proprioceptive Neuromuscular Facilitation (PNF) and Passive Vertebral Mobilization (PVM)-on neck pain, disability, and movement.

This randomized controlled trial was conducted at the University of Lahore Teaching Hospital over nine months. A total of 62 participants, aged 18 to 35 years, who had mechanical neck pain for at least four weeks, were recruited and randomly assigned to one of two groups: Group A received PNF, while Group B received PVM. Both treatments were delivered by physiotherapists three times per week for four weeks.

PNF is an active therapy that involves specific movement patterns to improve muscle coordination and flexibility. PVM is a passive manual therapy technique where the therapist gently moves the neck vertebrae to improve joint mobility and reduce pain.

Outcomes were measured using the Neck Disability Index (NDI), the Numeric Pain Rating Scale (NPRS), and measurements of neck movement (Active Cervical Range of Motion, or ACROM) at the start of the study, at two weeks, and at the end of the four-week treatment. The study was single-blinded-meaning the person assessing the outcomes did not know which treatment the patient received.

The results showed that both treatments significantly improved pain, movement, and function. However, the group that received PNF showed slightly greater reduction in pain scores by the end of the treatment. There were no significant differences between the groups in terms of disability or movement range.

This study concluded that both PNF and PVM are beneficial treatments for mechanical neck pain. PNF may offer slightly faster pain relief, while both interventions are effective at improving mobility and reducing neck-related disability. These findings can help guide physiotherapists and patients in choosing suitable treatment options for neck pain.

Full description

Mechanical neck pain is a common musculoskeletal condition often caused by poor posture, repetitive stress, or mechanical strain involving cervical joints, ligaments, and muscles. It is typically localized and not associated with radiating symptoms. This condition leads to functional disability, reduced cervical range of motion (ROM), and increased pain, significantly affecting individuals' quality of life and work productivity. While various physiotherapeutic approaches are employed in its management, the comparative efficacy of Proprioceptive Neuromuscular Facilitation (PNF) and Passive Vertebral Mobilization (PVM) remains inadequately explored in controlled settings.

This randomized controlled trial aimed to evaluate and compare the effectiveness of PNF and PVM techniques in improving neck-related disability, reducing pain, and enhancing active cervical ROM in individuals diagnosed with mechanical neck pain. The study was conducted at the University of Lahore Teaching Hospital and followed ethical approval and informed consent protocols. The trial design was single-blinded, with the assessor unaware of group allocation.

A total of 62 participants aged 18-35 years with clinically diagnosed mechanical neck pain of at least 4 weeks duration were included using purposive sampling. Participants were randomly allocated (via lottery method) into two equal groups (n = 31 per group): Group A received PNF techniques, and Group B received Maitland-based passive vertebral mobilization.

Group A (PNF) intervention involved rhythmic initiation, dynamic reversals, and contract-relax patterns performed across diagonal cranio-cervical movement patterns. Group B (PVM) received graded Maitland mobilizations (Grades I-IV) targeting the cervical vertebrae. Both groups received physiotherapy three times per week for four consecutive weeks. Each treatment session lasted 15-30 minutes.

Outcome measures were recorded at baseline, week 2, and week 4 and included:

Neck Disability Index (NDI): to assess functional limitation

Numeric Pain Rating Scale (NPRS): to measure subjective pain intensity

Active Cervical Range of Motion (ACROM): measured using a goniometer

Statistical analysis using SPSS Version 24 revealed that both groups experienced statistically significant improvements over time in all outcome measures:

NDI (F = 355.163, p < .001)

NPRS (F = 544.090, p < .001)

ACROM (F = 33.413, p < .001)

Between-group comparisons showed no significant difference for NDI (p = .769) or ACROM (p = .987). However, PNF demonstrated significantly greater pain reduction at baseline (p = .039) and at week four (p = .043), suggesting superior short-term analgesic effects.

This trial demonstrated that both PNF and PVM are effective in reducing neck disability and improving cervical mobility and pain. PNF may offer enhanced short-term pain relief due to its neuromuscular activation mechanisms, while PVM remains an effective passive intervention for joint mobilization.

The study's findings provide clinicians with evidence supporting both interventions, allowing treatment selection based on individual patient presentation, therapist skill, and rehabilitation goals. Future studies with larger samples and longer follow-up periods are recommended to assess long-term efficacy, retention of benefits, and cost-effectiveness.

Enrollment: 62 patients

Sex: All

Ages: 18 to 35 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Participants aged between 18 and 35 years were included in the study (Ashfaq et al., 2022).
• Participants diagnosed with pain localized in the neck region for at least 4 weeks were included.
• Participants diagnosed with no radiating pain beyond the shoulder or fingers were included (Cohen, 2015).
• Participants diagnosed with no identified neurological deficits were included.
• Participants having no history of major trauma or surgery to the cervical spine were included (Rodríguez-Huguet et al., 2020).

Exclusion criteria

• Participants who were diagnosed with ankylosing spondylitis, rheumatoid arthritis, fracture of spine, cancer or congenital anomaly of the cervical spine, positive neurological findings (Ashfaq et al., 2022).
• Patients with any other contraindication to manual therapy (Ashfaq et al., 2022).
• Neurological conditions affecting the cervical spine.
• Uncontrolled dizziness or vertigo (Cohen, 2015).
• Known malignancy or any pregnancy (Cohen, 2015).
• Current use of medications that could affect pain perception (e.g., opioids, high-dose antidepressants) (Rodríguez-Huguet et al., 2020)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

62 participants in 2 patient groups

Proprioceptive Neuromuscular Facilitation (PNF)

Experimental group

Description:

Participants in this arm received Proprioceptive Neuromuscular Facilitation (PNF) techniques aimed at improving neck mobility, pain, and function. The intervention included rhythmic initiation, dynamic reversals, and contract-relax techniques performed across four cranio-cervical diagonal movement patterns (e.g., extension with left rotation, flexion with right rotation). Each session lasted 15-30 minutes and was delivered three times per week for four weeks. Techniques were progressed based on patient tolerance, with repetitions increased in the third and fourth weeks. All sessions were administered by licensed physiotherapists following standardized protocols.

Treatment:

Other: Proprioceptive Neuromuscular Facilitation (PNF)

Passive Vertebral Mobilization (PVM)

Experimental group

Description:

Participants in this arm received Maitland-based Passive Vertebral Mobilization (PVM) techniques targeting cervical vertebrae to improve joint mobility and reduce neck pain. Mobilizations were applied in prone lying using posteroanterior central and unilateral glides. Treatment began with Grades I-II oscillatory mobilizations in Weeks 1-2, progressing to Grades III-IV in Weeks 3-4, based on patient response and tolerance. Each session lasted 15-20 minutes and was conducted three times per week for four weeks. Interventions were performed by trained physiotherapists using standardized procedures.

Treatment:

Other: Passive Vertebral Mobilization (PVM)