Effectiveness of SNAGs, Self-SNAGs and NAGs in cervical spine disorders: A Systematic Review and Meta-Analysis

Background: Cervical spine musculoskeletal disorders (CSMD) such as mechanical neck pain (MNP), cervicogenic dizziness (CGD), cervicogenic headache (CGH), cervical radiculopathy (CR) and cervical spondylosis (CS) are common in the general population. They generate symptoms like pain and decrease in cervical range of motion (ROM) and functional limitation. The techniques introduced by Brian Mulligan such as Sustained Natural Apophyseal Glides (SNAGs) or Natural Apophyseal Glides (NAGs has been really popular in the last decade to manage CSMD. Purpose: To provide a comprehensive overview of the current literature concerning Mulligan techniques used to manage CSMD. Method: Electronic data searches were performed in November 2018. Randomized controlled trials (RCT) that involved adults with CSMD that compared Mulligan techniques to another treatment or to a placebo intervention were included. Two reviewers independently conducted selection, data extraction and assessment of risk of bias. Data from studies investigating similar diagnosis, interventions and outcomes were pooled in Review Manager. Main results: Twenty studies investigated the effectiveness of Mulligan techniques in patients suffering from MNP (10), CGD (4), CGH (3), CR (2) and CS (1) were included. Significant improvement of pain intensity, ROM and disability were reported in patients with MNP, CR and CS. Intensity and frequency of dizziness as well as disability were improved in patients with CGD. Significant improvement of headache severity and ROM were reported in patients with CGH. Conclusions: The Mulligan techniques applied to the cervical spine are safe and simple interventions that could potentially be beneficial for patients with CSMD. Larger randomized controlled trials, using rigorous methodology, in different CSMD are warranted.