Comparison of Suboccipital Release and Muscle Energy Technique in Subjects With Mechanical Neck Pain and Forward Head Posture

Mechanical neck pain may be accompanied by upper trapezius trigger points, which are tender muscle spots associated with pain and restricted movement. Spray-and-stretch and sustained-pressure techniques are used to manage these symptoms, but their comparative short-term effects remain uncertain.

This study will evaluate the additional effects of each technique when combined with the same conventional physiotherapy programme. The comparison will examine both the immediate response to the first treatment session and the response after completion of the two week programme. It will focuse on whether differences between the treatments will be observed across pain, cervical mobility, and neck-related disability.

• Spray and Stretch Technique (Other): With the participant seated comfortably, a vapocoolant spray will be applied in 3-5 parallel sweeps over the upper trapezius muscle, followed by stretching of the affected muscle. The procedure will be repeated 2-3 times per session. Participants will receive six sessions, three times weekly for two weeks, alongside conventional physiotherapy.
• Sustained Pressure Technique (Other), also known as Sustained Compression, Ischemic Compression: The therapist will apply sustained manual pressure to upper trapezius trigger points, adjusting the pressure according to the participant's tolerance. Pressure application will be repeated during each session. Participants will receive six sessions, three times weekly for two weeks, alongside conventional physiotherapy.
• Conventional Physiotherapy (Other): Both groups will receive a hot pack over the upper trapezius for 10 minutes, cervical isometric exercises, active neck movement exercises, shoulder shrugs, retraction exercises, and advice on posture and neck care. Exercises will be progressed during the second week. Conventional physiotherapy will provide during six sessions, three times weekly for two weeks.

Primary outcomes

• Pain intensity [Baseline, immediately after the first treatment session, and after the sixth treatment session (2 weeks).]: Pain Intensity Measured Using the Visual Analogue Scale
• Cervical range of motion [Baseline, immediately after the first treatment session, and after the sixth treatment session (2 weeks).]: Active cervical range of motion will be measured in degrees using a goniometer. Measurements included flexion, extension, right and left lateral flexion, and right and left rotation. Higher values indicate greater range of motion.
• Neck Related Disability Measured Using the Neck Disability Index [Baseline, immediately after the first treatment session, and after the sixth treatment session (2 weeks)]: The Neck Disability Index assesses the effect of neck pain on daily activities through 10 items, each scored from 0 to 5. The total raw score ranges from 0 to 50, with higher scores indicating greater disability.

Sex: All, ages: 20 Years to 30 Years

Inclusion Criteria:Adults aged 20-40 years, of either sex.

Chronic mechanical neck pain lasting at least three months.

At least one upper trapezius trigger point with painful restriction of cervical range of motion.

Forward head posture.

Pain intensity below 7 on the 0-10 Visual Analogue Scale. -

Exclusion Criteria:Fibromyalgia.

Previous cervical spine surgery.

Thoracic outlet syndrome.

Cervical radiculopathy.

Skin infection or open wounds in the cervical region.

Cervical tumour.

Cervical spine fracture.

Use of steroid therapy.

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• Amna Zia, PhD. Scholar, Principal investigator, King Edward Medical University, Lahore
• Annusha Arshad, Principal investigator, King Edward Medical University, Lahore