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CTRI Number  CTRI/2024/09/073626 [Registered on: 09/09/2024] Trial Registered Prospectively
Last Modified On: 28/08/2024
Post Graduate Thesis  Yes 
Type of Trial  Interventional 
Type of Study   Physiotherapy (Not Including YOGA) 
Study Design  Randomized, Parallel Group Trial 
Public Title of Study   Mulligans SNAG Technique Versus Maitland’s in case of non-specific neck pain with reduced cervical rotation Among College Students.  
Scientific Title of Study   Comparative Study On The Efficacy Of Mulligans SNAG Technique Versus Maitland’s Mobilization On Pain & Range of Motion In Case Of Non-specific Upper Cervical Neck Pain Among College Students.  
Trial Acronym  NIL 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Prakash Pandey 
Designation  MPT student 
Affiliation  Mahatma Gandhi University Of Medical Sciences and Technology, Jaipur 
Address  Mahatma Gandhi physiotherapy college, Mahatma Gandhi University of medical sciences and technology, RIICO Institutional Area , Sitapura, Tonk Road

Jaipur
RAJASTHAN
302022
India 
Phone  9874989763  
Fax    
Email  prakash2006@mgumst.org  
 
Details of Contact Person
Scientific Query  
Name  Dr Madhusudan Tiwari 
Designation  Dean and Principal 
Affiliation  Mahatma Gandhi University of medical sciences and Technology, Jaipur 
Address  Mahatma Gandhi University of medical sciences and technology, RIICO Institutional Area , Sitapura, Tonk Road

Jaipur
RAJASTHAN
302022
India 
Phone  8290964159  
Fax    
Email  principal.physiotherapy@mgumst.org  
 
Details of Contact Person
Public Query  
Name  Dr Madhusudan Tiwari 
Designation  Dean and Principal 
Affiliation  Mahatma Gandhi University of medical sciences and Technology, Jaipur 
Address  Mahatma Gandhi University of medical sciences and technology, RIICO Institutional Area , Sitapura, Tonk Road

Jaipur
RAJASTHAN
302022
India 
Phone  8290964159  
Fax    
Email  principal.physiotherapy@mgumst.org  
 
Source of Monetary or Material Support  
Mahatma Gandhi physiotherapy college, Mahatma Gandhi University of medical sciences and technology, RIICO Institutional Area , Sitapura, Tonk Road, Jaipur, Rajasthan (India), 302022 
 
Primary Sponsor  
Name  Prakash Pandey 
Address  P 145 3rd Flat 4C nandani kannan apartment, bandhab nagar colony, DumDum cantt, Kolkata, Westbengal (India) 700028  
Type of Sponsor  Other [Self] 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Madhusudan Tiwari  Mahatma Gandhi hospital, Jaipur  Room no. 14 ,Physiotherapy OPD, Basement.
Jaipur
RAJASTHAN 		 8290964159

principal.physiotherapy@mgumst.org 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Institutional Ethics committee, Mahatma Gandhi Medical college and Hospital,MGUMST,Jaipur  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: M542||Cervicalgia,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Comparator Agent  Maitland manual Technique(Grade II & III)   Maitland manual Technique(Grade II & III). All the participants will be given 8-10 minutes of moist heat therapy in a sitting position while leaning onto a couch, with moist heat therapy placed on the posterior aspect of the neck and upper scapular area. The Maitland manual technique will be applied after the completion of moist heat therapy. The patient will be asked to comfortably lie down on the couch in the prone position with the face comfortably placed on the headspace of the couch. The therapist will then expose the area of the cervical spine and inspect for any passive restrictions of the upper cervical spine. The therapist will stand in front of the patients head so that the patients body is perpendicular to the therapist. The tissue slack will be eliminated by asking the patient to relax the neck into a slight extension and contact will be made only with the bony prominence. The therapist will then join the dorsal aspect of each thumb together and place the pad areas of the thumb on the desired spinous process of the cervical vertebrae. For unilateral glide, the thumb will be placed at the desired transverse process together and the therapist will now stand towards the side of the desired transverse process at the side of the patients head. The grade II PA glide will gently be applied via the thumb of the therapist towards the ground at the frequency of 60Hz, 2-3 oscillations per second over the desired vertebrae for 60 seconds in each repetition. The therapist will progressively increase the grade II PA glide towards grade III as the patient becomes more comfortable at the same frequency of 60Hz, 2-3 oscillations per second over the desired vertebrae. The therapist will give 6 repetitions of 60 seconds each in one session. The therapist will give 3 sessions per week for a total of 3 weeks of intervention throughout the study.  
Intervention  Mulligan’s SNAG Technique   Mulligan’s manual technique All the participants will be given 8-10 minutes of moist heat therapy in a sitting position while leaning onto a couch, with moist heat therapy placed on the posterior aspect of the neck and upper scapular area. The Mulligan SNAG technique will be applied after the completion of moist heat therapy. The patient will be then asked to sit well-supported in a chair. The therapist will set the head and spine in an anatomically neutral position. The therapist will place the medial border of the right thumb on the posterior part of the articular pillar or lamina below the vertebrae to be mobilized. The therapist will take up the slack of soft tissue to place contact with vertebrae to be moved. The therapist will place the pad of the left thumb perpendicular to the nail of the right thumb and glide will be sustained through it. The therapist will then generate a nonpainful PA glide through the pad of the left thumb on the desired vertebrae and sustain it. The therapist will ask the patient to move their neck in the direction of previously produced symptoms. If the glide is symptom-free, then the patient applies an over-pressure over his/her face further into the movement of restriction via right hand for right side rotation and left hand for left side rotation. The therapist will regularly ask the patient if the glide and pressure are symptom-free for each repetition. The SNAG will be given for 6 repetitions in 3 sets per session. The SNAG will be given for 3 weeks including 3 sessions/week, a total of 9 sessions throughout the study.  
 
Inclusion Criteria  
Age From  18.00 Year(s)
Age To  28.00 Year(s)
Gender  Both 
Details 
Patients having complaints of neck pain and neck restriction for more than 2 weeks will be included.
Patients having reduced cervical rotation unilaterally or bilaterally of more than 8-10 degrees on a universal goniometer.
Patients having a pain score of 2 or above in NPRS scale Evaluation.
Exclusively college students will be included.
Patients not involved in any other Physiotherapy Treatment were included.
Patients willing to participate will be included.
Patients who are able to follow commands and able to comprehend will be included.
 
 
ExclusionCriteria 
Details  Patients having any other orthopedic conditions around the cervical region will be excluded.
Patients with recent or past surgery around the cervical or shoulder region will be excluded.
Patients with any neurological impairment or disturbances will be excluded.
Patients receiving any other Physiotherapy treatment will be excluded.
Patients with any metabolic disease of bone and joints will be excluded.
Patients with any tumor or metastasis will be excluded.
Patients with any vascular disease will be excluded.
Patients with congenital neck deformities will be excluded.
Patients with hypersensitivity to skin will be excluded.
 
 
Method of Generating Random Sequence   Coin toss, Lottery, toss of dice, shuffling cards etc 
Method of Concealment   An Open list of random numbers 
Blinding/Masking   Participant and Outcome Assessor Blinded 
Primary Outcome  
Outcome  TimePoints 
Numerical Pain Rating Scale
Universal Goniometer  		 3 weeks 
 
Secondary Outcome  
Outcome  TimePoints 
Numerical Pain rating scale
Universal goniometer  		 2 weeks 
 
Target Sample Size   Total Sample Size="50"
Sample Size from India="50" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   Phase 3 
Date of First Enrollment (India)   30/09/2024 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="0"
Months="6"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Not Yet Recruiting 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - NO
Brief Summary  

PROCEDURE-


The eligibility of the participants will be taken on the basis of the inclusion criteria of this research study.


50 subjects will be randomly selected according to the inclusion criteria and they will be assigned with the consent forms.


Two groups will be divided randomly (Group A and Group B) each with n=25 participants respectively.


Group A- This group will have n=25 Participants and will be given intervention of Mulligan’s manual technique 


All the participants will be given 8-10 minutes of moist heat therapy in a sitting position while leaning onto a couch, with moist heat therapy placed on the posterior aspect of the neck and upper scapular area.

The Mulligan SNAG technique will be applied after the completion of moist heat therapy.

The patient will be then asked to sit well-supported in a chair.

The therapist will set the head and spine in an anatomically neutral position.

The therapist will place the medial border of the right thumb on the posterior part of the articular pillar or lamina below the vertebrae to be mobilized.

The therapist will take up the slack of soft tissue to place contact with vertebrae to be moved.

The therapist will place the pad of the left thumb perpendicular to the nail of the right thumb and glide will be sustained through it.

The therapist will then generate a nonpainful PA glide through the pad of the left thumb on the desired vertebrae and sustain it.

The therapist will ask the patient to move their neck in the direction of previously produced symptoms.

If the glide is symptom-free, then the patient applies an over-pressure over his/her face further into the movement of restriction via right hand for right side rotation and left hand for left side rotation.

The therapist will regularly ask the patient if the glide and pressure are symptom-free for each repetition.

The SNAG will be given for 6 repetitions in 3 sets per session.

The SNAG will be given for 3 weeks including 3 sessions/week, a total of 9 sessions throughout the study. 




Group B-  This group will have n=25 Participants and will be given the intervention of the Maitland manual Technique(Grade II & III).

All the participants will be given 8-10 minutes of moist heat therapy in a sitting position while leaning onto a couch, with moist heat therapy placed on the posterior aspect of the neck and upper scapular area.

The Maitland manual technique will be applied after the completion of moist heat therapy.

The patient will be asked to comfortably lie down on the couch in the prone position with the face comfortably placed on the headspace of the couch.

The therapist will then expose the area of the cervical spine and inspect for any passive restrictions of the upper cervical spine.

The therapist will stand in front of the patient’s head so that the patient’s body is perpendicular to the therapist.

The tissue slack will be eliminated by asking the patient to relax the neck into a slight extension and contact will be made only with the bony prominence.

The therapist will then join the dorsal aspect of each thumb together and place the pad areas of the thumb on the desired spinous process of the cervical vertebrae.

For unilateral glide, the thumb will be placed at the desired transverse process together and the therapist will now stand towards the side of the desired transverse process at the side of the patient’s head.

The grade II PA glide will gently be applied via the thumb of the therapist towards the ground at the frequency of 60Hz, 2-3 oscillations per second over the desired vertebrae for 60 seconds in each repetition.

The therapist will progressively increase the grade II PA glide towards grade III as the patient becomes more comfortable at the same frequency of 60Hz, 2-3 oscillations per second over the desired vertebrae.

The therapist will give 6 repetitions of 60 seconds each in one session.

The therapist will give 3 sessions per week for a total of 3 weeks of intervention throughout the study.

 
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