Barbosa-Silva Jordana, Luc Alexandre, Sobral de Oliveira-Souza Ana Izabela, Martins de Abreu Raphael, Cipriano Jakelline, de Schaetzen Marine, Pitance Laurent, Armijo-Olivo Susan
Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrück, Germany.
Physiother Res Int. 2025 Jul;30(3):e70045. doi: 10.1002/pri.70045.
Mulligan's techniques, such as Sustained Natural Apophyseal Glides (SNAGs) and Natural Apophyseal Glides (NAGs), are commonly applied by physiotherapists when treating patients with non-specific neck pain (NP). However, there has been no comprehensive synthesis of their effects in NP. This review aimed to assess the effectiveness of Mulligan's techniques in reducing pain, improving disability, and enhancing cervical range of motion (CROM) in adults with acute, subacute, or chronic NP.
A systematic review with meta-analysis was conducted on randomized controlled trials (RCTs) comparing Mulligan's techniques with other interventions in adults with NP. Two reviewers independently conducted study selection, data extraction, and risk of bias (RoB) assessment. Meta-analyses were performed when clinical homogeneity was present; otherwise, a narrative synthesis was used. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Thirty-three studies were included. For acute and mixed (acute/subacute/chronic) NP, Mulligan's techniques were no more effective than other interventions for pain reduction, disability improvement, or CROM enhancement. However, in patients with chronic or uncertain chronicity NP, SNAGs combined with other interventions demonstrated superior outcomes-both statistically and sometimes clinically-compared to certain treatments like exercises and muscle-energy techniques, for reducing pain and disability and improving CROM. The certainty of evidence was rated very low.
Mulligan's techniques appear to be safe, simple, and potentially beneficial for managing mixed or chronic NP when combined with other interventions, presenting results that may be comparable or occasionally superior to other standard techniques.
Physiotherapists may consider incorporating Mulligan's techniques, especially SNAGs, within broader NP treatment strategies, as they offer a feasible, low-risk option for improving patient outcomes, particularly for chronic NP cases when used alongside other therapies.
穆利根技术，如持续自然关节突滑动（SNAGs）和自然关节突滑动（NAGs），在物理治疗师治疗非特异性颈部疼痛（NP）患者时常用。然而，对于其在颈部疼痛中的效果尚无全面的综合分析。本综述旨在评估穆利根技术在减轻急性、亚急性或慢性颈部疼痛成人患者疼痛、改善功能障碍及增加颈椎活动范围（CROM）方面的有效性。
对比较穆利根技术与其他干预措施治疗颈部疼痛成人患者的随机对照试验（RCT）进行系统综述和荟萃分析。两名评价者独立进行研究筛选、数据提取和偏倚风险（RoB）评估。当存在临床同质性时进行荟萃分析；否则，采用叙述性综合分析。使用推荐分级、评估、制定与评价（GRADE）方法对证据的确定性进行评级。
纳入33项研究。对于急性和混合型（急性/亚急性/慢性）颈部疼痛，穆利根技术在减轻疼痛、改善功能障碍或增加颈椎活动范围方面并不比其他干预措施更有效。然而，在慢性或慢性病程不明确的颈部疼痛患者中，与运动疗法和肌肉能量技术等某些治疗方法相比，SNAGs联合其他干预措施在减轻疼痛和功能障碍以及增加颈椎活动范围方面，在统计学上和有时在临床上都显示出更好的效果。证据的确定性被评为非常低。
穆利根技术似乎安全、简单，与其他干预措施联合使用时，对治疗混合型或慢性颈部疼痛可能有益，其结果可能与其他标准技术相当，或偶尔优于其他标准技术。
物理治疗师可考虑在更广泛的颈部疼痛治疗策略中纳入穆利根技术，特别是SNAGs，因为它们为改善患者预后提供了一种可行、低风险的选择，尤其是在与其他疗法联合用于慢性颈部疼痛病例时。
