Effects of cervical traction mobilization with mulligan’s SNAGS on Pain, cardiovascular and respiratory outcomes among young adults with cervical pain.


  • Zoya Mehmood Shifa Tameer-e-Millat University, Islamabad.
  • Umama Ijaz Advanced Diagnostic Centre, Islamabad.
  • Iqra Imtiaz Shifa Tameer-e-Millat University, Islamabad.
  • Asmar Fatima Riphah International University, Islamabad.
  • Muhammad Junaid Akram Islam College of Physical Therapy, Sialkot.
  • Naveed Ahmed District Headquarter Hospital, Haripur.
  • Ibraheem Zafar Shifa Tameer-e-Millat University, Islamabad.




Blood Pressure, Cervical Pain, Heart Rate, Oxygen Saturation, Respiratory Rate, Range of Motion, Traction


Objective: To determine the effect of Mulligan’s Cervical Sustained natural Apophyseal glide and cervical traction cardiovascular and respiratory outcomes; systolic blood pressure, diastolic blood pressure, heart rate, ventilation rate, oxygen saturation, neck disability index and cervical range of motion. Study Design: Randomized Control Trial. Setting: Shifa Tameer-e-Millat University, Islamabad Pakistan. Period: November 2021 to March 2022. Material & Methods: A total of 84 participants with age range of 18 to 24 years of either gender with cervical pain and hypo mobility were included in the study whereas individuals with history of cervical trauma or injury, any structural deformity, vertebral instability, cardiac and respiratory complications were excluded. These participants were randomly allocated into two groups by using toss and trial method. Experimental group received sustained natural apophyseal glide and traction while the control group was subjected to traction alone. A total of four sessions were provided over a course of four weeks, with two weeks interval between them. Pre and post vitals including blood pressure, heart rate, respiratory rate and oxygen saturation were monitored at each session along with Numeric Pain Rating scale, Neck disability index and cervical range of motion. Results: Mean age of the participants was 21.70±2 years. Both groups showed significant reduction in pain with p value< 0.05 whereas heart rate was significantly increased in experimental group with pre median 81.75(16.6) and post median 82.00(15.05). Flexion range of motion was significantly improved in experimental group with pre median 69.00(15) and post median 71.00(11.7). Cervical left side bending was significantly improved with p value 0.04. Other variables including ventilation rate, oxygen saturation, systolic and diastolic blood pressure, Neck Disability Index, and other cervical range of motion showed no statistically significant difference with p value >0.05. Conclusion: The study results show improvement in both groups in terms of cardiovascular and respiratory outcomes but experimental group has more significant reduction in pain and change in pulse rate.

Author Biographies

Zoya Mehmood, Shifa Tameer-e-Millat University, Islamabad.

MS-OMPT, Lecturer Rehabilitation Sciences, 

Umama Ijaz, Advanced Diagnostic Centre, Islamabad.

MS-OMPT, Physical Therapist, 

Iqra Imtiaz, Shifa Tameer-e-Millat University, Islamabad.

MS-WHPT, Lecture Rehabilitation Sciences, 

Asmar Fatima, Riphah International University, Islamabad.

MS-OMPT, Senior Lecturer Rehabilitation Sciences, 

Muhammad Junaid Akram, Islam College of Physical Therapy, Sialkot.

MS-NMPT, Ph.D Scholar, Assistant Professor Physical Therapy, 

Naveed Ahmed, District Headquarter Hospital, Haripur.

MS-OMPT, District Physiotherapist Physical Therapy, 

Ibraheem Zafar, Shifa Tameer-e-Millat University, Islamabad.

MS-CPPT, Lecturer Rehabilitation Sciences,