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

NCT06996015 | Recruiting

• 1 other identifier: REC/RCR&AHS/24/0154
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

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.

Conditions

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

Keywords

snags; Non-Specific Neck Pain; Craniovertebral Angle; disability

Outcome Measures

Primary Outcomes (2)

• NPRS

  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

  4th week

• Neck Disability Index

  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)

  4th week

Secondary Outcomes (1)

• Craniovertebral Angle

  4th week

Study Arms (2)

Cognitive Behavior Therapy

EXPERIMENTAL

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.

Other: Cognitive behavior therapy

Cervical Stabilization Exercises

ACTIVE COMPARATOR

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.

Other: Cervical Stabilization Exercises

Interventions

Cognitive behavior therapy OTHER

The treatment session will begin with a 10-minute conventional therapy, including a 5-minute hot pack applied to the cervical region and a 5-minute Myofascial Release (MFR) using skin rolling and cross-hand techniques to relax and stretch the fascia layers. This will be followed by a 10-minute application of Sustained Natural Apophyseal Glides (SNAGs), where the physiotherapist will guide the patient's active neck movements with accessory glides to improve joint ROM and reduce pain. Lastly, a 20-minute Cognitive Behavioral Therapy (CBT) session will include visual aids, explanations of cervical spine biomechanics, pain pathways, ergonomics, and posture management. Patients will receive manuals summarizing key points and be encouraged to engage actively. The 40-minute session will be conducted twice weekly for four weeks

Cognitive Behavior Therapy

Cervical Stabilization Exercises OTHER

The treatment session will last 40 minutes, twice a week for 4 weeks. It begins with a 10-minute conventional treatment: a 5-minute hot pack application to the cervical region followed by a 5-minute Myofascial Release (MFR) using the skin rolling technique. Natural wax will be applied for smooth strokes. MFR will engage all fascia layers with superficial strokes, progressing to deeper fascia using cross-hand stretch, depending on the pain tolerance. Next, SNAGs (Sustained Natural Apophyseal Glides) will be applied for 10 minutes. The patient, seated, will actively move the painful joint through its range of motion while the therapist applies a glide force. This will be repeated 10 times for 3 sets. Then session includes 20 minutes of Cervical Stabilization Exercises (CSE) with bracing in neurodevelopment stages (supine, prone, quadrupedal, bipedal), holding each position for 10 seconds. Isometric exercises and functional training with elastic bands and exercise balls follow.

Cervical Stabilization Exercises

Eligibility Criteria

• Age: 18 Years - 28 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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.

You may not qualify if:

• 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)

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Syeda Khatoon e Jannat Trust Hospital,

Faisalabad, Punjab Province, 38000, Pakistan

RECRUITING

MeSH Terms

Conditions

Neck Pain

Interventions

Cognitive Behavioral Therapy

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• Hira Shaukat, TDPT

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, pHD

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 10, 2025
• First Posted: May 30, 2025
• Study Start: June 10, 2025
• Primary Completion: October 1, 2025
• Study Completion: December 10, 2025
• Last Updated: July 4, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)