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

NCT07042230 | Completed DMC

• 1 other identifier: Rec-UOL-/506/08/24
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

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

Keywords

Articular; Cervical Vertebrae; Manual Therapy; Neck Pain; Proprioception; Range of Motion

Outcome Measures

Primary Outcomes (1)

• Neck Disability

  The Neck Disability Index (NDI) is a validated, self-reported questionnaire that assesses disability related to neck pain. It contains 10 items, each scored from 0 to 5, with higher scores indicating greater disability. The total score ranges from 0 to 50 and is converted into a percentage. This outcome will assess improvement in neck-related function and disability following 4 weeks of intervention with either PNF or PVM.

  Baseline, Week 2, and Week 4

Secondary Outcomes (2)

• Cervical Pain

  Baseline, Week 2, and Week 4

• Active Cervical Range of Motion (ACROM)

  Baseline, Week 2, and Week 4

Study Arms (2)

Proprioceptive Neuromuscular Facilitation (PNF)

EXPERIMENTAL

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.

Other: Proprioceptive Neuromuscular Facilitation (PNF)

Passive Vertebral Mobilization (PVM)

EXPERIMENTAL

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.

Other: Passive Vertebral Mobilization (PVM)

Interventions

Proprioceptive Neuromuscular Facilitation (PNF) OTHER

Proprioceptive Neuromuscular Facilitation (PNF) techniques were applied to the cervical region using rhythmic initiation, dynamic reversals, and contract-relax methods. Movements followed diagonal cranio-cervical patterns including flexion/extension with rotational components. Each session lasted 15-30 minutes, delivered three times per week for four weeks. Repetitions and sets were progressively increased based on patient tolerance. The goal was to enhance neuromuscular coordination, improve cervical range of motion, and reduce pain through active facilitation techniques.

Also known as: PNF Stretching, PNF Cervical Patterns

Proprioceptive Neuromuscular Facilitation (PNF)

Passive Vertebral Mobilization (PVM) OTHER

Passive Vertebral Mobilization (PVM) was administered using Maitland mobilization techniques applied to the cervical spine. Posteroanterior central and unilateral glides were performed with the participant in a prone position. Mobilizations started with Grades I-II during Weeks 1-2 and progressed to Grades III-IV in Weeks 3-4, depending on patient response. Each session lasted 15-20 minutes and was conducted three times weekly over four weeks. This passive manual therapy aimed to improve joint mobility, reduce muscle stiffness, and alleviate mechanical neck pain.

Also known as: Cervical Maitland Mobilization, Spinal Mobilization Techniques

Passive Vertebral Mobilization (PVM)

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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).

You may not qualify if:

• 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)

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

The University of Lahore Teaching Hospital

Lahore, 54590, Pakistan

Location

MeSH Terms

Conditions

Neck Pain

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Physiotherapist

Study Record Dates

• First Submitted: June 18, 2025
• First Posted: June 27, 2025
• Study Start: August 17, 2024
• Primary Completion: April 16, 2025
• Study Completion: June 6, 2025
• Last Updated: June 27, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)