Effectiveness of Mulligan’s Sustained Natural Apophyseal Glide (SNAG) over First Rib in Reducing Pain and Improving Cervical Rotation in Individuals with Mechanical Neck DysfunctionCorrespondence Address :
Dr. Kanthanathan Subbiah,
Associate Professor, Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), 1, Ramachandra Nagar, Porur-600116, Chennai, Tamil Nadu, India.
Introduction: Mechanical Neck Pain (MNP) is any type of pain caused by placing abnormal stress and strain on the structures that constitute the vertebral column. Elevated first rib dysfunction is one potential somatic lesion that could lead to neck pain. Little information is available regarding this somatic lesion and its management.
Aim: To assess the impact of treating first rib dysfunction with Mulligan’s Sustained Natural Apophyseal Glide (SNAG) among subjects with mechanical neck dysfunction.
Materials and Methods: A quasi-experimental-study with 40 patients with elevated first rib and neck pain were included in this study. After baseline evaluation comprising of history, pain intensity, Pressure Pain Threshold (PPT), Cervical Range of Motion (CROM) and Neck Disability Index (NDI), the subjects were divided into two groups (n=20). The Experimental group was treated with SNAG with neck isometrics and the control group was treated with interferential therapy with neck isometrics. After six sessions of treatment the PPT, CROM and NDI were measured. The results were tested using Paired t-test and Mann-Whitney U-tests with a statistical significance level set at p<0.05.
Results: Subjects in experimental group had clinically significant improvement post-treatment on Pain (p<0.002), Pressure Pain Threshold (PPT) (p<0.009), Cervical rotation range (p<0.001) and Neck disability (p<0.001) when compared to the control group.
Conclusion: Treating the first rib elevation dysfunction with Mulligan SNAG will improve cervical range of motion, decrease pain and related disability.
Bubble inclinometer, First rib dysfunction, Mulligan therapy
Bhattarai Prayerna, Kanthanathan Subbiah, P Antony Leo Asser, Steve Milanese. EFFECTIVENESS OF MULLIGAN’S SUSTAINED NATURAL APOPHYSEAL GLIDE (SNAG) OVER FIRST RIB IN REDUCING PAIN AND IMPROVING CERVICAL ROTATION IN INDIVIDUALS WITH MECHANICAL NECK DYSFUNCTION. Journal of Clinical and Diagnostic Research [serial online] 2019 March [cited: 2019 Mar 26 ]; 13:YC21-YC24. Available from
Date of Submission: Sep 17, 2018
Date of Peer Review: Oct 08, 2018
Date of Acceptance: Jan 25, 2019
Date of Publishing: Mar 01, 2019
FINANCIAL OR OTHER COMPETING INTERESTS: None.
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