Comparison of MET and Mulligan Mobilization Snags in Reducing Neck Pain and Improving Functional Activities in Chronic Mechanical Neck Pain Patients

Abstract

Background: Chronic mechanical neck pain is a prevalent musculoskeletal disorder globally, often leading to significant disability and reduced quality of life. Manual therapy interventions such as Muscle Energy Techniques (METs) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are widely used, but comparative evidence regarding their effectiveness remains limited and inconsistent. Objective: To compare the effectiveness of Mulligan SNAGs versus METs in reducing neck pain, improving functional disability, and enhancing cervical range of motion in patients with chronic mechanical neck pain. Methods: A single assessor, patient-blinded randomized clinical trial was conducted at the Physiotherapy Department of Mayo Hospital, Lahore, from January to April 2024. Fifty-five patients with chronic mechanical neck pain were randomized to receive either Mulligan SNAGs or METs alongside conventional physiotherapy over a four-week period. Primary and secondary outcomes included the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), and cervical range of motion (flexion and extension), assessed at baseline and post-intervention. Results: Both interventions yielded significant within-group improvements (p<0.001); however, post-treatment between-group comparisons demonstrated that SNAGs achieved greater reductions in pain (mean difference -4.60, 95% CI -5.38 to -3.82), disability (mean difference -10.93, 95% CI -12.68 to -9.18), and superior improvements in cervical flexion (+9.86°, 95% CI 5.11 to 14.61) and extension (+21.13°, 95% CI 16.91 to 25.35), all statistically significant (p<0.001). Conclusion: Mulligan SNAGs are more effective than METs in improving pain, functional disability, and cervical mobility in patients with chronic mechanical neck pain, supporting their preferential use in clinical practice.