THE EFFICACY OF SELF SNAG-SUSTAINED NATURAL APOPHYSEAL GLIDES VERSES – SNAGS APPLIED BY THERAPIST IN SUBACUTE MECHANICAL NECK PAIN AMONG DIAMOND WORKERS – A COMPARITIVE STUDY
MPT Scholar, Department of Physiotherapy, Janardhan Rai Nagar Rajasthan Vidhyapeeth University, Udaipur
Dr. Shailendra Mehta
Principal, Department of Physiotherapy, Janardhan Rai Nagar Rajasthan Vidhyapeeth University, Udaipur
OBJECTIVES – randomized clinical trial
STUDY DESIGN – evaluate the effectiveness of the Self –Snag Versus Snag applied by therapist.
BACKGROUND-Neck pain is common .More than half of the people develop neck pain some times in their life .Subject were evaluated on the basis of inclusion and exclusion criteria. Mulligan has described Self-Snags and Snags given by the therapist effective in subacute mechanical neck pain but no comparative study has been done.
METHOD-A sample of 30 subject (Mean + SD age,29.67+6.76) with subacute mechanical neck pain among diamond worker were randomized into two groups, Self –Snag (group-A) given by the therapist(group-B). The treatment was taken for 3 months regularly and outcome measures (VAS,ROM,NDI) were taken on day 0, day 45, day 90. Postural advice are also given to the subjects.
RESULTS- VAS, ROM AND NDI were statistically significant for PAIN, ROM, and DISABILITY (p<0.01)indicating greater improvement in both groups for all the three outcome measure. On comparing the pre and post test score, the score showed greater improvement in PAIN, ROM, and NDI in group B receiving therapist SNAG than group A receiving SELF SNAG(p<0.01).
CONCLUSION-The result of this study suggest that SNAG given by the therapist in subacute mechanical neck pain provide superficial clinical benefits than SELF-SNAG.
Background of the problem:
Neck pain is common more than half of people develop a bout of neck pain at some time in
their life once survey done in the U.K. found that, of adults aged 45 to 75 years
about one in for women and about one in 5 men had current neck pain,
Mechanical neck pain – is the most common type, this is sometimes called ‘simple or non-specific’ neck pain cause include minor injuries or sprains to muscles or ligaments in the neck. Bad —posture is also a common cause. For example; neck pain is more common in people who spend much time at their working day at a desk with a ‘bent-forward’ posture.
Symptoms – pain develops in the neck and may spread to the base of the skull and shoulders movement of the neck may make the pain worse, the pain may spread down an arm to hand or figures. This is due to irritation of a nerve going to the arm from the spinal cord in the neck.
Outlook – is usually good in most cases of acute (sudden onset) neck pain. Symptoms commonly begins to improve after few days, and are usually gone within a few weeks, some people develop chronic neck pain.
Mechanism of pain- a forward head posture incurred from an increased dorsal spinal kyphosis places the head ahead of the center of gravity. This posture becomes pathologic when it is maintained persistently.
MULLIGAN CONCEPT- of mobilization with movements (mwms), first used in cervical spine ,carry the acronym SNAGS, stand for sustained natural epiphyseal glides, used to improve function, restriction or pain in flexion ,extension, rotation, side flexion of cervical. SELF-SNAGS with a small hand towel can also be beneficial.
Need and significance of the study:
Neck pain is common more than half of people develop a bout of neck pain at some time in their life once survey done in the UK found that, of adults aged 45 to 75 years about one in for women and about one in 5 men had current neck pain.
Study shows that both SELF-SNAGS with hot pack and SNAGS given by therapist with hot pack separately enable a patient to relief fast but no comparative study was
being done that is why I took up this study ,to find out which will give faster and better result in mechanical neck pain.
Statement of the problem:
This study is done to find out the significance difference between SELF-SNAGS and SNAGS
given by therapist in improving the Chronic Mechanical Neck Pain
Neck disability index
As a service to those with neck pain, we are including the neck disability index as a
self- administered test to determine their level of disability. Simply add
the score from answer to the questions and check the sum against the
VISUAL ANALOGE SCALE-
A simple assessment tool consisting of a 10 cm line with 0 one end, representing no pain and 10 on other, representing the worst pain ever experienced which a patient marks to indicate the severity of his or her pain.
OBJECTIVE OF THE STUDY
To see the effectiveness of Self- Snags versus Snags applied by therapist
on range of motion via Goniometer.
See the effectiveness of Self- Snags versus Snags applied by therapist on VAS. To see the effectiveness of Self- Snags versus Snags applied by therapist on Neck Disability Index.
It is a comparative study design; a sample of 30 patients will be included in the study with
a pre-test and post-test study design. Convenient sampling is done on basis
of baseline assessment and diagnosis of their condition, as per pediatrician .
All the subjects were taken from Janak Hospital .Bardoli
Thirty subjects with subacute mechanical neck pain of age group between 20-50 years are taken. Each subject is evaluated for the study. All the patients were referred by consultant orthopedician from the referred hospital and diagnosed as a subacute mechanical neck pain and who satisfy the inclusion criteria.
By using convenient sampling thirty subjects studied were divided into two group of fifteen
Group A—SELF SNAGS
Group B—SNAGS GIVEN BY THERAPIST
Data Collection Process:
Prior sanction was obtained for the study. The patients referred by the
orthopedic surgeon of the hospital were taken for primary evaluation and if
the patient fulfilled the inclusion criteria, they were selected for the study. The
referred patient who satisfy the inclusion criteria were included in the study
and were divided in two groups
Group A —Self- Snag
Group B- Snag given by therapist using random sampling
Assessment was taken of all the 30 patient using VAS scale for pain,
Goniometer for measuring Rom and Neck Disability Index for disability at O
day, 45th day and 90th day.
Procedure: – After scoring for inclusion and exclusion criteria patient are tested for pain by VAS, Rom by Goniometer, and disability by NDI.
Subjects were assigned to group I to group Il. 15 patients were in each group.
Group A: – Was in self-snags protocol. Subjects were taught carefully Self Snag for extension, rotation and lateral flexion of cervical spine with the help of small hand towel.
Group B- Received SNAGS by therapist. 1st hot pack was applied for 15 – 20 minute then snag was applied by therapist using 2 — 3 set of 4 — 6 repetition for each level of cervical spine, for improving extension, rotation, and side flexion.
STATISTICAL TEST USED
Independent ’t’ test and Paired ‘t’ test were used to compare pain, ROM and neck Disability
between the groups and within groups.
Both groups response to treatment was analyzed using t test.
In these 30 subjects were randomly selected and were allocated in group A and B. There were 17 male 13 females. Mean age of 29.67± 6.76 ranging from 20 to 50 years with minimal age of 20 and maximal age of 40 in group A and the mean age of 30.33±7.72 with a minimal age of 20 and maximum age of 46 in group B.
ANALYSIS AND INTERPRETATION:
All the analysis were obtained using SPSS window version 10.Demographic data of patient including Sex , Age, Diseases Duration, VAS, Range of Motion ,Neck Disability Index were descriptive summarized. The dependent variables for statistical analysis were help to overcome Subacute Mechanical Neck pain, ROM, NDI .An alpha level of 0.05 was used to determine statistical significance. Statistical technique used for analysis was independent t test and paired test which is applicable to compare between two groups and within the group at significant level.
The result of the present study demonstrated that there was a significant improvement in subacute mechanical pain. When two samples were conducted after 45th day, 90th day using VAS scale , it was found that there was a significant improvement in neck pain after 45th days with p=0.022, and highly significant after 31 days in group B compare to group A, p=0.00.
Table: Data analysis of VAS between group A and group B
Group A (N=15) M ± SD
Group B (N=15) M±SD
0 DAY 6.33±.98 6.27±1.03 0.182 0.857 45 DAY 4.40±.99 3.47±1.13 2.146 .022 90 DAY 2.67±1.11 .73±.96 5.09 .000
Figure: Demographic presentation of VAS scale differences between group A and group B
Table: Data analysis of rotations on Goniometer between group A and group B
Group A M±SD
Group B M±SD
RtR LtR RtR LtR RtR LtR RtR LtR 0 day 27.53±4.70 29.27±5.23 27.73±4.65 30.20±5.39 .117 .481 .908 .634 45 day 30±4.80 32.20±4.65 34.27±3.39 36.53±4.22 -2.814 -2.672 .009 .012 90 day 33.80±4.18 35.73±4.23 40.00±1.51 41.33±2.09 -5.404 -4.59 .000 .000
0 DAY 45 DAY 90 DAY
Figure: Demographic presentation between group A and group B on Goniometer for rotations
0 day 45 day 90 day
0 day 45 day 90 day
Table: Data analysis of side flexion on Goniometer between group A and group B
Group A M±SD
Group B M±SD
RtR LtR RtR LtR RtR LtR RtR LtR 0 day 14.20±1.93 15.67±2.09 14.87±1.60 16.80±2.48 -1.029 .1.351 .312 .187 45 day 15.87±1.64 17.13±1.92 17.67±1.45 19.0±1.56 -3.18 -2.921 .004 .007 90 day 17.60±1.45 18.87±1.30 19.67±.90 20.47±1.13 -4.68 -3.60 .000 .000
Right Side Flexion
0 day 45 day 90 day
Figure: demographic presentation between group A and group B on Goniometer for side flexions
Table : Data analysis of NDI between group A and group B
GroupA(n=15) M±SD NDI
GroupB(n=15) M±SD NDI
0 DAY 9.47.±3.11 9.67±2.66 -.189 .851 45 DAY 7.13±2.33 5.47|±1.60 2.28 .030 90 DAY 4.60±1.35 1.33±1.45 6.388 .000
0 day 45 day 90 day
Figure: Demographic presentation of NDI between group A and group B
Table: Data analysis of extension on Goniometer between group A and group B
0 DAY 33.13±4.32 30.73±4.77 1.443 0.160
45 DAY 37.07±4.13 36.53±2.53 .426 .673
90 DAY 40.13±2.53 41.93±.1.28 -2.45 .020
0 day 45 day 90 day
Figure: Demographic presentation between group A and group B on Goniometer for
The present study was under taken to determine the effectiveness of Self Snags
versus snags applied by therapist in Subacute Mechanical Neck Pain among
Diamond worker. The study of 3 month structured, snags had shown
improvement in Subacute Mechanical neck pain
Data collection through the study showed more improvement in subacute Mechanical Neck pain patient in group B. Thus it can be concluded that snags applied by therapist are more beneficial in improving Subacute Mechanical Neck Pain.
The most objective of the study was to compare the improvement in Pain, Range of Motion and Neck Disability between group A and group B subjects. When analyzed the mean value for pre and post test on 0 day, 45 day and 90 day, it is found that the mean value of:-
0 DAY 45 DAY 90 DAY
VAS scale is 6.33 and 6.27 for group A and group B subjects respectively for pre test. The values are found to be increased in post test on 45th day that are 4.40 and 3.47 and on 90th day that are 2.67 and .73 for group A group B respectively. It is found statistically that group B is more significant (p=.000).
Range of motion on Goniometer for right and left rotation 27.53, 29.27 and 27.73, 30.20 for group A group B subjects respectively for pre test. The values are found to be increased in post test on 45th day that are 30, 32.20 and 34.27, 36.73 and on 90th day that are 33.80, 35.73 and 40 ,41.33 for group A group B respectively. It is found statistically that group B is more significant (p=.OOO).
Graphs of between the groups showed Self Snag and Snags given by therapist were similar and serve as homogeneity groups and there were no significant difference between these two groups,
Graphical presentations, which point to over all sense of the study depicts the same. All graphs show the significant difference for improvement in Subacute Mechanical Neck Pain in Group A and Group B separately. The level of mean difference in pre test and post test of both groups presented Subacute Mechanical Neck Pain improvement more in Group B than Group A.
Results of study
It has been recorded from the study that use of Self-Snags and Snags applied by therapist produces significant improvement in subacute mechanical neck pain among diamond worker. It can be seen that use of Self-Snags and Snags applied by therapist in patients with Subacute Mechanical Neck Pain is beneficial. But result shows that group B showed faster and better improvement than group A. Hence alternate hypothesis is accepted and the null hypothesis is rejected.
The present study was performed to note the efficacy of self –snags verses snags applied by the therapist subacute mechanical neck pain among diamond workers.
30 subjects were diagnosed to have subacute mechanical neck pain were selected and divided into two group with n=15 for each group. The group A was treated with self –snags, whereas group B was treated with snags applied by therapist for 3 month.
Subject in both the groups were assessed for pain, ROM and Neck Disability at a 0 day,45th day and 90th day and the result were statistically analyzed using independent ttest and paired t-test .Then it can be concluded that snags applied by the therapist group showed a marked improvement in sub-acute mechanical neck pain when compared self- snags.
Neck exercise program was not included
The study was only done on diamond worker not on other
Further studies should be done on all the patient with sub-acute mechanical neck pain fulfilling the inclusion criteria and studies should also included neck strengthening program.
It has been recorded from the study that use of self snags and snags applied by the therapist produces significant improvement in sub-acute mechanical neck pain among diamond worker. It can be seen that use of Self Snags and Snag applied by the therapist in patient with Sub-Acute Mechanical Neck Pain is beneficial. But Snag applied by the therapist give faster improvement in Subacute Mechanical Neck Pain than Self Snags .
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