Natural apophyseal glides

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Natural apophyseal glides
Specialty physical therapy

Natural apophyseal glides (NAGS) refers to a spinal physical therapy treatment technique developed by Brian Mulligan. [1]

Contents

Technique

NAGS involves a mid to end-range facet joint mobilisation applied anterocranially along the plane of treatment within the desired joint, combined with a small amount of manual traction. The purpose of this treatment is to increase movement within the spine, and decrease symptomatic pain. [1]

Sustained natural apophyseal glides

Sustained natural apophyseal glides (SNAGS) are a separate technique involving a combination of a sustained facet glide with active motion, which is then followed by overpressure. [1]

Clinical evidence

A 2010 study concluded that whilst both NAGS and SNAGS showed signs of effectiveness, SNAGS demonstrated greater statistically significant efficacy over NAGS in reducing pain and disability in subjects with chronic neck pain. [2] Another study suggested that Mulligan's mobilisation (i.e. NAGS and SNAGS), Maitland's mobilisation and the McKenzie approach were all effective in relieving pain and improving range of motion in cases of chronic cervical spondylosis with unilateral radiculopathy. [3]

A 2008 randomised controlled trial by Reid et al. suggested a statistically significant correlation between SNAGS treatment and reduced dizziness, cervical pain and disability caused by cervical dysfunction, [4] whilst another randomised controlled trial in 2007 by Hall et al. suggested that a self-sustained C1-C2 SNAG technique was effective in managing cervicogenic headache. [5] A 2008 study by Moutzouri et al. suggested that SNAG mobilisation did not demonstrate significant effectiveness to increase the range of motion in patients with low back pain. [6]

See also

Related Research Articles

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Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.

<span class="mw-page-title-main">Back pain</span> Area of body discomfort

Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia based on the segment affected. The lumbar area is the most common area affected. An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, and may include numbness or weakness in the legs and arms.

<span class="mw-page-title-main">Tension headache</span> Medical condition

Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain usually radiates from the lower back of the head, the neck, the eyes, or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Degenerative disc disease</span> Loss of function in the spines intervertebral discs

Degenerative disc disease (DDD) is a medical condition typically brought on by the aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with or without symptoms, but is typically identified once symptoms arise. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the tough outer layers of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.

<span class="mw-page-title-main">Spinal adjustment</span> Chiropractic technique

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<span class="mw-page-title-main">Spinal manipulation</span> Intervention performed on spinal joints

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<span class="mw-page-title-main">Traction (orthopedics)</span> Process for straightening broken bones

Traction is a set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction. They are used in orthopedic medicine.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

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<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. MUA is used by osteopathic/orthopedic physicians, chiropractors and specially trained physicians. It aims to break up adhesions on or around spinal joints or extremity joints to which a restricted range of motion can be painful and limit function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.

Joint mobilization is a manual therapy intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion rather than osteokinematic joint motion. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect. These techniques are used by a variety of health care professionals with specific training in manual therapy assessment and treatment techniques.

<span class="mw-page-title-main">Neck pain</span> Medical condition

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Passive accessory intervertebral movements (PAIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland. The purpose of PAIVM is to assess the amount and quality of movement at various intervertebral levels, and to treat pain and stiffness of the cervical and lumbar spine.

Passive physiological intervertebral movements (PPIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland used to assess intervertebral movement at a single joint, and to mobilise neck stiffness.

<span class="mw-page-title-main">Forward head posture</span> Spinal condition

Forward head posture (FHP) is an excessively kyphotic (hunched) thoracic spine. It is clinically recognized as a form of repetitive strain injury. The posture can occur in dentists, surgeons, and hairdressers, or people who spend time on electronic devices. It is one of the most common postural issues. There is a correlation between forward head posture and neck pain in adults, but not adolescents.

Nerve glide, also known as nerve flossing or nerve stretching, is an exercise that stretches nerves. It facilitates the smooth and regular movement of peripheral nerves in the body. It allows the nerve to glide freely along with the movement of the joint and relax the nerve from compression. Nerve gliding cannot proceed with injuries or inflammations as the nerve is trapped by the tissue surrounding the nerve near the joint. Thus, nerve gliding exercise is widely used in rehabilitation programs and during the post-surgical period.

Fascial Manipulation is a manual therapy technique developed by Italian physiotherapist Luigi Stecco in the 1980s, aimed at evaluating and treating global fascial dysfunction by restoring normal motion/gliding to the system.

References

  1. 1 2 3 Brian R. Mulligan (2004). Manual therapy: NAGS, SNAGS, MWMS etc. (5th Ed). Plane View Services Ltd. ISBN   9780476011540
  2. Nikeeta P. (2010). Comparative effectiveness of natural appophyseal glides and suatained natural apophyseal glides in chronic neck pain – A randomized clinical trial. KLE University, Belgaum, Karnataka.
  3. Kulkarni, S. (2010). Comparative Effectiveness Of Three Manual Therapy Techniques In Chronic Cervical Spondylosis With Unilateral Radiculopathy-A Randomized Clinical Trial. KLE University, Belgaum, Karnataka.
  4. Susan A. Reid, Darren A. Rivett, Michael G. Katekar, Robin Callister (2008). Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness, Manual Therapy, Volume 13, Issue 4, pp.357-366. doi : 10.1016/j.math.2007.03.006
  5. Hall, T., Chan, H. T., Christensen, L., Odenthal, B., Wells, C., & Robinson, K. (2007). Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. Journal of Orthopaedic and Sports Physical Therapy, 37(3), 100.
  6. Moutzouri, M., Billis, E., Strimpakos, N., Kottika, P., & Oldham, J. A. (2008). The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system. BMC Musculoskeletal disorders, 9(1), 131.